- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $770.09 / $770.09 / $989.56
| Facility | | $770.09 | $770.09 | $989.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $638.16 / $792.91 / $1,155.14
| Professional | | $638.16 | $792.91 | $1,155.14 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,374.17 / $1,687.59 / $2,814.12
| Facility | | $1,374.17 | $1,687.59 | $2,814.12 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $839.51 / $839.51 / $1,428.26
| Professional | | $839.51 | $839.51 | $1,428.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,036.33 / $1,036.33 / $1,036.33
| Facility | | $1,036.33 | $1,036.33 | $1,036.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $756.53 / $1,014.07 / $1,067.43
| Professional | | $756.53 | $1,014.07 | $1,067.43 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $596.82 / $789.88 / $1,131.05
| Professional | | $596.82 | $789.88 | $1,131.05 |