- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,344.23 / $4,466.84 / $7,413.10
| Facility | | $2,344.23 | $4,466.84 | $7,413.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $478.63 / $5,370.32 / $8,128.31
| Professional | | $478.63 | $5,370.32 | $8,128.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $512.86 / $707.95 / $4,073.80
| Facility | | $512.86 | $707.95 | $4,073.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $660.69 / $660.69 / $660.69
| Professional | | $660.69 | $660.69 | $660.69 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $575.44 / $2,511.89 / $6,606.93
| Facility | | $575.44 | $2,511.89 | $6,606.93 |