- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,023.29 / $3,981.07 / $6,760.83
| Facility | | $1,023.29 | $3,981.07 | $6,760.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $524.81 / $870.96 / $2,089.30
| Professional | | $524.81 | $870.96 | $2,089.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $933.25 / $1,584.89 / $8,128.31
| Facility | | $933.25 | $1,584.89 | $8,128.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,174.90 / $1,445.44 / $1,778.28
| Professional | | $1,174.90 | $1,445.44 | $1,778.28 |
- 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 |