- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $743.40 / $7,882.56 / $9,688.19
| Facility | | $743.40 | $7,882.56 | $9,688.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $579.54 / $730.16 / $897.67
| Professional | | $579.54 | $730.16 | $897.67 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $558.54 / $886.01 / $1,109.96
| Professional | | $558.54 | $886.01 | $1,109.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,132.00 / $7,826.47 / $17,761.09
| Facility | | $6,132.00 | $7,826.47 | $17,761.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $736.11 / $1,038.30 / $1,676.00
| Professional | | $736.11 | $1,038.30 | $1,676.00 |