- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $894.71 / $915.62 / $1,217.17
| Facility | | $894.71 | $915.62 | $1,217.17 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $750.19 / $979.06 / $1,373.42
| Professional | | $750.19 | $979.06 | $1,373.42 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,633.84 / $1,950.95 / $3,260.24
| Facility | | $1,633.84 | $1,950.95 | $3,260.24 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $979.06 / $979.06 / $1,479.75
| Professional | | $979.06 | $979.06 | $1,479.75 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,018.60 / $1,018.60 / $1,018.60
| Facility | | $1,018.60 | $1,018.60 | $1,018.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $743.58 / $743.58 / $2,056.13
| Professional | | $743.58 | $743.58 | $2,056.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $677.71 / $884.83 / $1,278.76
| Professional | | $677.71 | $884.83 | $1,278.76 |