- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $973.87 / $973.87 / $7,548.53
| Facility | | $973.87 | $973.87 | $7,548.53 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $889.55 / $973.87 / $1,172.33
| Professional | | $889.55 | $973.87 | $1,172.33 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,109.01 / $1,286.64 / $1,401.81
| Facility | | $1,109.01 | $1,286.64 | $1,401.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,246.06 / $1,246.06 / $1,246.06
| Professional | | $1,246.06 | $1,246.06 | $1,246.06 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,186.91 / $1,186.91 / $1,186.91
| Facility | | $1,186.91 | $1,186.91 | $1,186.91 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,004.88 / $1,538.84 / $4,970.43
| Professional | | $1,004.88 | $1,538.84 | $4,970.43 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $723.45 / $1,121.45 / $1,661.41
| Professional | | $723.45 | $1,121.45 | $1,661.41 |