- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $954.99 / $1,445.44 / $2,398.83
| Facility | | $954.99 | $1,445.44 | $2,398.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,467.37 / $4,677.35 / $7,413.10
| Professional | | $3,467.37 | $4,677.35 | $7,413.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,606.93 / $7,762.47 / $10,471.29
| Facility | | $6,606.93 | $7,762.47 | $10,471.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,235.94 / $4,570.88 / $6,025.60
| Professional | | $3,235.94 | $4,570.88 | $6,025.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,290.87 / $5,011.87 / $7,244.36
| Professional | | $2,290.87 | $5,011.87 | $7,244.36 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $660.69 / $1,659.59 / $5,248.07
| Facility | | $660.69 | $1,659.59 | $5,248.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,019.95 / $3,981.07 / $6,456.54
| Professional | | $3,019.95 | $3,981.07 | $6,456.54 |