- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,513.56 / $4,073.80 / $12,589.25
| Facility | | $1,513.56 | $4,073.80 | $12,589.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,071.52 / $1,584.89 / $7,244.36
| Professional | | $1,071.52 | $1,584.89 | $7,244.36 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,548.13 / $4,677.35 / $9,120.11
| Facility | | $3,548.13 | $4,677.35 | $9,120.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $288.40 / $1,230.27 / $4,365.16
| Facility | | $288.40 | $1,230.27 | $4,365.16 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $295.12 / $1,230.27 / $4,466.84
| Facility | | $295.12 | $1,230.27 | $4,466.84 |