- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,023.29 / $2,630.27 / $6,606.93
| Facility | | $1,023.29 | $2,630.27 | $6,606.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,230.27 / $1,412.54 / $1,862.09
| Professional | | $1,230.27 | $1,412.54 | $1,862.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $489.78 / $1,348.96 / $7,244.36
| Facility | | $489.78 | $1,348.96 | $7,244.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,258.93 / $1,621.81 / $10,715.19
| Professional | | $1,258.93 | $1,621.81 | $10,715.19 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $489.78 / $1,995.26 / $7,943.28
| Facility | | $489.78 | $1,995.26 | $7,943.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,174.90 / $1,584.89 / $2,290.87
| Professional | | $1,174.90 | $1,584.89 | $2,290.87 |