- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,570.88 / $8,511.38 / $12,302.69
| Facility | | $4,570.88 | $8,511.38 | $12,302.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $467.74 / $10,471.29 / $13,489.63
| Professional | | $467.74 | $10,471.29 | $13,489.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7,413.10 / $7,413.10 / $8,128.31
| Professional | | $7,413.10 | $7,413.10 | $8,128.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $467.74 / $741.31 / $1,174.90
| Facility | | $467.74 | $741.31 | $1,174.90 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,318.26 / $2,884.03 / $7,762.47
| Facility | | $1,318.26 | $2,884.03 | $7,762.47 |