- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,650.46 / $2,510.21 / $7,530.63
| Facility | | $1,650.46 | $2,510.21 | $7,530.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,330.41 / $1,650.46 / $1,757.15
| Professional | | $1,330.41 | $1,650.46 | $1,757.15 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,419.60 / $3,236.41 / $6,212.77
| Facility | | $1,419.60 | $3,236.41 | $6,212.77 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $959.60 / $1,246.88 / $1,656.73
| Professional | | $959.60 | $1,246.88 | $1,656.73 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,791.91 / $3,485.55 / $11,419.70
| Facility | | $2,791.91 | $3,485.55 | $11,419.70 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,886.74 / $4,573.60 / $6,200.22
| Professional | | $2,886.74 | $4,573.60 | $6,200.22 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,154.70 / $1,673.47 / $4,405.17
| Professional | | $1,154.70 | $1,673.47 | $4,405.17 |