- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $977.24 / $4,570.88 / $7,079.46
| Facility | | $977.24 | $4,570.88 | $7,079.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $616.60 / $977.24 / $2,344.23
| Professional | | $616.60 | $977.24 | $2,344.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $933.25 / $1,698.24 / $6,606.93
| Facility | | $933.25 | $1,698.24 | $6,606.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,380.38 / $1,548.82 / $1,862.09
| Professional | | $1,380.38 | $1,548.82 | $1,862.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,715.35 / $6,309.57 / $9,772.37
| Facility | | $3,715.35 | $6,309.57 | $9,772.37 |