- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,975.02 / $2,688.63 / $9,800.16
| Facility | | $1,975.02 | $2,688.63 | $9,800.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,117.93 / $2,217.23 / $2,422.19
| Professional | | $1,117.93 | $2,217.23 | $2,422.19 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,017.49 / $3,638.68 / $5,827.39
| Facility | | $2,017.49 | $3,638.68 | $5,827.39 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,863.22 / $1,863.22 / $1,863.22
| Facility | | $1,863.22 | $1,863.22 | $1,863.22 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,211.08 / $1,211.08 / $1,211.08
| Facility | | $1,211.08 | $1,211.08 | $1,211.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $782.55 / $931.61 / $2,422.19
| Professional | | $782.55 | $931.61 | $2,422.19 |