- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $929.38 / $946.92 / $1,208.80
| Facility | | $929.38 | $946.92 | $1,208.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $785.65 / $988.46 / $1,355.06
| Professional | | $785.65 | $988.46 | $1,355.06 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,798.13 / $1,924.93 / $3,596.26
| Facility | | $1,798.13 | $1,924.93 | $3,596.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,000.82 / $1,002.36 / $1,454.05
| Professional | | $1,000.82 | $1,002.36 | $1,454.05 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,028.38 / $1,028.38 / $1,028.38
| Facility | | $1,028.38 | $1,028.38 | $1,028.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $750.72 / $750.72 / $1,977.94
| Professional | | $750.72 | $750.72 | $1,977.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $680.25 / $897.07 / $1,351.31
| Professional | | $680.25 | $897.07 | $1,351.31 |