- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,312.88 / $2,362.50 / $11,638.46
| Facility | | $1,312.88 | $2,362.50 | $11,638.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,140.02 / $1,312.88 / $1,510.30
| Professional | | $1,140.02 | $1,312.88 | $1,510.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,169.70 / $1,436.39 / $2,041.92
| Professional | | $1,169.70 | $1,436.39 | $2,041.92 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,681.02 / $9,787.84 / $22,601.24
| Facility | | $6,681.02 | $9,787.84 | $22,601.24 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,259.09 / $1,594.81 / $2,255.92
| Professional | | $1,259.09 | $1,594.81 | $2,255.92 |