- 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
- $543.87 / $702.65 / $1,026.24
| Professional | | $543.87 | $702.65 | $1,026.24 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $554.86 / $767.98 / $1,272.54
| Professional | | $554.86 | $767.98 | $1,272.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $662.08 / $927.68 / $1,245.21
| Professional | | $662.08 | $927.68 | $1,245.21 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,569.00 / $4,571.00 / $7,350.00
| Facility | | $2,569.00 | $4,571.00 | $7,350.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $466.49 / $843.54 / $1,330.75
| Professional | | $466.49 | $843.54 | $1,330.75 |