- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $966.65 / $996.28 / $1,249.01
| Facility | | $966.65 | $996.28 | $1,249.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $804.30 / $1,030.05 / $1,459.74
| Professional | | $804.30 | $1,030.05 | $1,459.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,810.85 / $2,232.44 / $3,666.98
| Facility | | $1,810.85 | $2,232.44 | $3,666.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,043.98 / $1,048.81 / $1,822.20
| Professional | | $1,043.98 | $1,048.81 | $1,822.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,473.53 / $1,473.53 / $1,473.53
| Facility | | $1,473.53 | $1,473.53 | $1,473.53 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,075.68 / $1,377.26 / $1,517.74
| Professional | | $1,075.68 | $1,377.26 | $1,517.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $773.32 / $974.22 / $1,474.86
| Professional | | $773.32 | $974.22 | $1,474.86 |