- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,074.61 / $1,397.00 / $4,478.00
| Facility | | $1,074.61 | $1,397.00 | $4,478.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $807.58 / $1,097.43 / $1,281.77
| Professional | | $807.58 | $1,097.43 | $1,281.77 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,727.30 / $6,727.30 / $8,072.76
| Facility | | $6,727.30 | $6,727.30 | $8,072.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $969.77 / $1,212.21 / $1,283.52
| Professional | | $969.77 | $1,212.21 | $1,283.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,565.00 / $3,709.00 / $7,779.00
| Facility | | $1,565.00 | $3,709.00 | $7,779.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $826.63 / $1,157.28 / $1,712.03
| Professional | | $826.63 | $1,157.28 | $1,712.03 |