- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,023.63 / $7,291.00 / $9,887.52
| Facility | | $1,023.63 | $7,291.00 | $9,887.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $318.47 / $427.14 / $1,260.66
| Professional | | $318.47 | $427.14 | $1,260.66 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $337.34 / $519.89 / $1,626.46
| Professional | | $337.34 | $519.89 | $1,626.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,856.58 / $6,334.70 / $14,250.18
| Facility | | $2,856.58 | $6,334.70 | $14,250.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,068.58 / $1,506.37 / $2,737.84
| Professional | | $1,068.58 | $1,506.37 | $2,737.84 |