- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,995.26 / $4,466.84 / $10,232.93
| Facility | | $1,995.26 | $4,466.84 | $10,232.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,148.15 / $1,949.84 / $3,019.95
| Professional | | $1,148.15 | $1,949.84 | $3,019.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $446.68 / $1,737.80 / $1,737.80
| Professional | | $446.68 | $1,737.80 | $1,737.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,288.25 / $2,344.23 / $7,244.36
| Facility | | $1,288.25 | $2,344.23 | $7,244.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,778.28 / $2,398.83 / $3,388.44
| Professional | | $1,778.28 | $2,398.83 | $3,388.44 |