- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,288.25 / $3,890.45 / $6,606.93
| Facility | | $1,288.25 | $3,890.45 | $6,606.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,467.37 / $5,495.41 / $6,760.83
| Professional | | $3,467.37 | $5,495.41 | $6,760.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $346.74 / $4,073.80 / $7,762.47
| Facility | | $346.74 | $4,073.80 | $7,762.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,715.35 / $5,495.41 / $37,153.52
| Professional | | $3,715.35 | $5,495.41 | $37,153.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $346.74 / $1,949.84 / $6,165.95
| Facility | | $346.74 | $1,949.84 | $6,165.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,548.13 / $4,677.35 / $8,317.64
| Professional | | $3,548.13 | $4,677.35 | $8,317.64 |