- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,187.76 / $6,165.95 / $12,589.25
| Facility | | $2,187.76 | $6,165.95 | $12,589.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,071.52 / $1,445.44 / $3,388.44
| Professional | | $1,071.52 | $1,445.44 | $3,388.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,888.44 / $7,762.47 / $15,135.61
| Facility | | $5,888.44 | $7,762.47 | $15,135.61 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,230.27 / $1,778.28 / $4,365.16
| Facility | | $1,230.27 | $1,778.28 | $4,365.16 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,096.48 / $1,819.70 / $6,760.83
| Facility | | $1,096.48 | $1,819.70 | $6,760.83 |