- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $870.96 / $3,981.07 / $6,760.83
| Facility | | $870.96 | $3,981.07 | $6,760.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $537.03 / $954.99 / $2,137.96
| Professional | | $537.03 | $954.99 | $2,137.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,023.29 / $10,471.29 / $34,673.69
| Facility | | $1,023.29 | $10,471.29 | $34,673.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,174.90 / $1,230.27 / $1,819.70
| Professional | | $1,174.90 | $1,230.27 | $1,819.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,549.93 / $16,218.10 / $34,673.69
| Facility | | $9,549.93 | $16,218.10 | $34,673.69 |