- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $967.26 / $987.42 / $1,279.14
| Facility | | $967.26 | $987.42 | $1,279.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $792.51 / $1,035.36 / $1,450.90
| Professional | | $792.51 | $1,035.36 | $1,450.90 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,776.59 / $2,211.98 / $3,521.06
| Facility | | $1,776.59 | $2,211.98 | $3,521.06 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,054.47 / $1,054.47 / $1,721.02
| Professional | | $1,054.47 | $1,054.47 | $1,721.02 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,232.72 / $1,232.72 / $1,232.72
| Facility | | $1,232.72 | $1,232.72 | $1,232.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $899.89 / $1,232.72 / $1,269.70
| Professional | | $899.89 | $1,232.72 | $1,269.70 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $762.43 / $1,035.60 / $1,383.58
| Professional | | $762.43 | $1,035.60 | $1,383.58 |