- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,071.52 / $3,981.07 / $6,760.83
| Facility | | $1,071.52 | $3,981.07 | $6,760.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $549.54 / $912.01 / $2,290.87
| Professional | | $549.54 | $912.01 | $2,290.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $977.24 / $1,659.59 / $8,128.31
| Facility | | $977.24 | $1,659.59 | $8,128.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,230.27 / $1,513.56 / $1,819.70
| Professional | | $1,230.27 | $1,513.56 | $1,819.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,162.28 / $5,495.41 / $8,912.51
| Facility | | $3,162.28 | $5,495.41 | $8,912.51 |