- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,445.44 / $3,090.30 / $6,309.57
| Facility | | $1,445.44 | $3,090.30 | $6,309.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,258.93 / $2,238.72 / $4,786.30
| Professional | | $1,258.93 | $2,238.72 | $4,786.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $416.87 / $1,348.96 / $1,995.26
| Facility | | $416.87 | $1,348.96 | $1,995.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $87.10 / $104.71 / $190.55
| Professional | | $87.10 | $104.71 | $190.55 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,548.13 / $4,897.79 / $7,244.36
| Facility | | $3,548.13 | $4,897.79 | $7,244.36 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,479.11 / $4,073.80 / $7,244.36
| Facility | | $1,479.11 | $4,073.80 | $7,244.36 |