- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,380.38 / $4,786.30 / $7,079.46
| Facility | | $1,380.38 | $4,786.30 | $7,079.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $794.33 / $1,202.26 / $3,090.30
| Professional | | $794.33 | $1,202.26 | $3,090.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,380.38 / $2,238.72 / $14,791.08
| Facility | | $1,380.38 | $2,238.72 | $14,791.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,737.80 / $1,995.26 / $2,344.23
| Professional | | $1,737.80 | $1,995.26 | $2,344.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,413.10 / $10,964.78 / $15,848.93
| Facility | | $7,413.10 | $10,964.78 | $15,848.93 |