- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,230.27 / $4,786.30 / $7,079.46
| Facility | | $1,230.27 | $4,786.30 | $7,079.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $512.86 / $891.25 / $2,290.87
| Professional | | $512.86 | $891.25 | $2,290.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,047.13 / $2,089.30 / $7,079.46
| Facility | | $1,047.13 | $2,089.30 | $7,079.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,174.90 / $1,621.81 / $1,862.09
| Professional | | $1,174.90 | $1,621.81 | $1,862.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,467.37 / $5,888.44 / $7,762.47
| Facility | | $3,467.37 | $5,888.44 | $7,762.47 |