- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,090.73 / $2,778.87 / $3,955.04
| Facility | | $2,090.73 | $2,778.87 | $3,955.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $524.04 / $726.37 / $832.38
| Professional | | $524.04 | $726.37 | $832.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $502.26 / $695.17 / $1,085.76
| Professional | | $502.26 | $695.17 | $1,085.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $724.14 / $896.27 / $1,173.78
| Professional | | $724.14 | $896.27 | $1,173.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,838.00 / $5,111.00 / $9,622.00
| Facility | | $2,838.00 | $5,111.00 | $9,622.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $503.10 / $823.59 / $1,231.68
| Professional | | $503.10 | $823.59 | $1,231.68 |