- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,479.11 / $4,786.30 / $7,079.46
| Facility | | $1,479.11 | $4,786.30 | $7,079.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $870.96 / $1,348.96 / $3,019.95
| Professional | | $870.96 | $1,348.96 | $3,019.95 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,174.90 / $2,137.96 / $7,762.47
| Facility | | $1,174.90 | $2,137.96 | $7,762.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,905.46 / $2,187.76 / $2,511.89
| Professional | | $1,905.46 | $2,187.76 | $2,511.89 |
- 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 |