- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $873.66 / $885.58 / $1,128.03
| Facility | | $873.66 | $885.58 | $1,128.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $752.36 / $902.61 / $1,294.05
| Professional | | $752.36 | $902.61 | $1,294.05 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,645.34 / $1,927.37 / $3,290.68
| Facility | | $1,645.34 | $1,927.37 | $3,290.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $935.05 / $943.02 / $1,429.79
| Professional | | $935.05 | $943.02 | $1,429.79 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,260.83 / $1,260.83 / $1,260.83
| Facility | | $1,260.83 | $1,260.83 | $1,260.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $920.41 / $1,132.57 / $1,344.11
| Professional | | $920.41 | $1,132.57 | $1,344.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $658.28 / $882.46 / $1,262.72
| Professional | | $658.28 | $882.46 | $1,262.72 |