- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,071.52 / $6,165.95 / $10,232.93
| Facility | | $1,071.52 | $6,165.95 | $10,232.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $870.96 / $1,548.82 / $3,235.94
| Professional | | $870.96 | $1,548.82 | $3,235.94 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,621.81 / $4,677.35 / $15,848.93
| Facility | | $1,621.81 | $4,677.35 | $15,848.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,949.84 / $1,995.26 / $3,019.95
| Professional | | $1,949.84 | $1,995.26 | $3,019.95 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,943.28 / $11,481.54 / $15,848.93
| Facility | | $7,943.28 | $11,481.54 | $15,848.93 |