- 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
- $541.88 / $755.42 / $830.06
| Professional | | $541.88 | $755.42 | $830.06 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $516.89 / $715.42 / $1,122.52
| Professional | | $516.89 | $715.42 | $1,122.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $745.22 / $938.02 / $1,213.57
| Professional | | $745.22 | $938.02 | $1,213.57 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,838.00 / $5,164.00 / $9,622.00
| Facility | | $2,838.00 | $5,164.00 | $9,622.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $524.52 / $841.20 / $1,273.36
| Professional | | $524.52 | $841.20 | $1,273.36 |