- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,416.26 / $1,927.98 / $7,027.58
| Facility | | $1,416.26 | $1,927.98 | $7,027.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $801.65 / $1,589.95 / $1,736.92
| Professional | | $801.65 | $1,589.95 | $1,736.92 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $547.09 / $597.91 / $663.68
| Professional | | $547.09 | $597.91 | $663.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,336.09 / $1,336.09 / $1,336.09
| Facility | | $1,336.09 | $1,336.09 | $1,336.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $868.46 / $9,437.04 / $10,144.61
| Facility | | $868.46 | $9,437.04 | $10,144.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $561.16 / $719.39 / $1,736.92
| Professional | | $561.16 | $719.39 | $1,736.92 |