- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,174.90 / $6,606.93 / $8,128.31
| Facility | | $1,174.90 | $6,606.93 | $8,128.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $707.95 / $1,047.13 / $3,311.31
| Professional | | $707.95 | $1,047.13 | $3,311.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,174.90 / $1,949.84 / $14,791.08
| Facility | | $1,174.90 | $1,949.84 | $14,791.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,548.82 / $1,737.80 / $1,995.26
| Professional | | $1,548.82 | $1,737.80 | $1,995.26 |
- 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 |