- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $963.48 / $964.56 / $1,200.77
| Facility | | $963.48 | $964.56 | $1,200.77 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $860.54 / $981.33 / $1,344.91
| Professional | | $860.54 | $981.33 | $1,344.91 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,720.43 / $2,062.01 / $3,440.86
| Facility | | $1,720.43 | $2,062.01 | $3,440.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,025.19 / $1,047.83 / $1,524.08
| Professional | | $1,025.19 | $1,047.83 | $1,524.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,212.63 / $1,212.63 / $1,226.18
| Facility | | $1,212.63 | $1,212.63 | $1,226.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $885.22 / $1,212.63 / $1,249.01
| Professional | | $885.22 | $1,212.63 | $1,249.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $715.25 / $906.02 / $1,409.06
| Professional | | $715.25 | $906.02 | $1,409.06 |