- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,148.15 / $4,786.30 / $7,079.46
| Facility | | $1,148.15 | $4,786.30 | $7,079.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $602.56 / $1,000.00 / $2,344.23
| Professional | | $602.56 | $1,000.00 | $2,344.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,071.52 / $1,819.70 / $8,128.31
| Facility | | $1,071.52 | $1,819.70 | $8,128.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,348.96 / $1,659.59 / $1,995.26
| Professional | | $1,348.96 | $1,659.59 | $1,995.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,162.28 / $5,495.41 / $8,912.51
| Facility | | $3,162.28 | $5,495.41 | $8,912.51 |