- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,200.35 / $2,995.38 / $10,918.30
| Facility | | $2,200.35 | $2,995.38 | $10,918.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,556.85 / $2,304.14 / $2,698.54
| Professional | | $1,556.85 | $2,304.14 | $2,698.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,349.27 / $1,349.27 / $1,349.27
| Facility | | $1,349.27 | $1,349.27 | $1,349.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,385.08 / $2,385.08 / $2,981.34
| Professional | | $2,385.08 | $2,385.08 | $2,981.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $830.32 / $1,037.90 / $3,113.70
| Professional | | $830.32 | $1,037.90 | $3,113.70 |