- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,288.25 / $4,786.30 / $7,079.46
| Facility | | $1,288.25 | $4,786.30 | $7,079.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $676.08 / $1,096.48 / $2,511.89
| Professional | | $676.08 | $1,096.48 | $2,511.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,202.26 / $2,041.74 / $8,912.51
| Facility | | $1,202.26 | $2,041.74 | $8,912.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,513.56 / $1,862.09 / $2,187.76
| Professional | | $1,513.56 | $1,862.09 | $2,187.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,786.30 / $7,585.78 / $10,232.93
| Facility | | $4,786.30 | $7,585.78 | $10,232.93 |