- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,122.02 / $5,370.32 / $8,128.31
| Facility | | $1,122.02 | $5,370.32 | $8,128.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $691.83 / $1,258.93 / $2,344.23
| Professional | | $691.83 | $1,258.93 | $2,344.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,380.38 / $8,128.31 / $14,454.40
| Facility | | $1,380.38 | $8,128.31 | $14,454.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,621.81 / $1,862.09 / $2,754.23
| Professional | | $1,621.81 | $1,862.09 | $2,754.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,244.36 / $11,481.54 / $15,135.61
| Facility | | $7,244.36 | $11,481.54 | $15,135.61 |