- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,096.48 / $6,165.95 / $10,232.93
| Facility | | $1,096.48 | $6,165.95 | $10,232.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $891.25 / $1,548.82 / $3,981.07
| Professional | | $891.25 | $1,548.82 | $3,981.07 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,348.96 / $4,466.84 / $15,848.93
| Facility | | $1,348.96 | $4,466.84 | $15,848.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,995.26 / $2,041.74 / $3,090.30
| Professional | | $1,995.26 | $2,041.74 | $3,090.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,413.10 / $10,715.19 / $15,848.93
| Facility | | $7,413.10 | $10,715.19 | $15,848.93 |