- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,243.54 / $2,897.44 / $134,935.94
| Facility | | $1,243.54 | $2,897.44 | $134,935.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,243.54 / $1,243.54 / $1,243.54
| Professional | | $1,243.54 | $1,243.54 | $1,243.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,170.39 / $1,170.39 / $1,170.39
| Professional | | $1,170.39 | $1,170.39 | $1,170.39 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,243.54 / $1,243.54 / $1,243.54
| Facility | | $1,243.54 | $1,243.54 | $1,243.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,109.44 / $1,219.16 / $1,975.99
| Professional | | $1,109.44 | $1,219.16 | $1,975.99 |