- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,071.52 / $5,370.32 / $7,943.28
| Facility | | $1,071.52 | $5,370.32 | $7,943.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $691.83 / $1,258.93 / $2,754.23
| Professional | | $691.83 | $1,258.93 | $2,754.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $933.25 / $1,819.70 / $7,413.10
| Facility | | $933.25 | $1,819.70 | $7,413.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,445.44 / $1,698.24 / $2,818.38
| Professional | | $1,445.44 | $1,698.24 | $2,818.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,137.96 / $5,248.07 / $7,413.10
| Facility | | $2,137.96 | $5,248.07 | $7,413.10 |