- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,266.59 / $7,177.75 / $20,416.20
| Facility | | $3,266.59 | $7,177.75 | $20,416.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,797.81 / $5,331.54 / $11,374.74
| Facility | | $4,797.81 | $5,331.54 | $11,374.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,167.83 / $1,895.79 / $1,895.79
| Professional | | $1,167.83 | $1,895.79 | $1,895.79 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,266.50 / $10,661.98 / $12,794.69
| Facility | | $5,266.50 | $10,661.98 | $12,794.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,916.60 / $3,958.41 / $9,002.09
| Professional | | $2,916.60 | $3,958.41 | $9,002.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,224.97 / $1,749.96 / $1,749.96
| Professional | | $1,224.97 | $1,749.96 | $1,749.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,177.83 / $2,395.61 / $3,048.96
| Professional | | $2,177.83 | $2,395.61 | $3,048.96 |