- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,225.07 / $1,770.06 / $4,252.05
| Facility | | $1,225.07 | $1,770.06 | $4,252.05 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $987.51 / $1,225.07 / $1,304.26
| Professional | | $987.51 | $1,225.07 | $1,304.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $224.97 / $2,734.28 / $4,611.47
| Facility | | $224.97 | $2,734.28 | $4,611.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $950.24 / $6,679.45 / $9,505.86
| Professional | | $950.24 | $6,679.45 | $9,505.86 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,211.08 / $5,166.05 / $10,693.72
| Facility | | $1,211.08 | $5,166.05 | $10,693.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,304.25 / $2,929.92 / $4,602.14
| Professional | | $1,304.25 | $2,929.92 | $4,602.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $782.55 / $1,117.93 / $3,269.76
| Professional | | $782.55 | $1,117.93 | $3,269.76 |