- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,071.52 / $3,981.07 / $6,456.54
| Facility | | $1,071.52 | $3,981.07 | $6,456.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $616.60 / $933.25 / $2,630.27
| Professional | | $616.60 | $933.25 | $2,630.27 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $812.83 / $1,778.28 / $7,079.46
| Facility | | $812.83 | $1,778.28 | $7,079.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,258.93 / $1,548.82 / $1,819.70
| Professional | | $1,258.93 | $1,548.82 | $1,819.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,168.69 / $6,309.57 / $8,912.51
| Facility | | $4,168.69 | $6,309.57 | $8,912.51 |