- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,258.93 / $4,786.30 / $7,079.46
| Facility | | $1,258.93 | $4,786.30 | $7,079.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $724.44 / $1,122.02 / $2,691.53
| Professional | | $724.44 | $1,122.02 | $2,691.53 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,258.93 / $2,089.30 / $17,782.79
| Facility | | $1,258.93 | $2,089.30 | $17,782.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,659.59 / $1,949.84 / $2,137.96
| Professional | | $1,659.59 | $1,949.84 | $2,137.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,511.38 / $11,748.98 / $19,498.45
| Facility | | $8,511.38 | $11,748.98 | $19,498.45 |