- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,445.44 / $5,623.41 / $6,918.31
| Facility | | $1,445.44 | $5,623.41 | $6,918.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,288.25 / $1,445.44 / $3,548.13
| Professional | | $1,288.25 | $1,445.44 | $3,548.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,479.11 / $3,715.35 / $10,715.19
| Professional | | $1,479.11 | $3,715.35 | $10,715.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,380.38 / $1,905.46 / $3,890.45
| Professional | | $1,380.38 | $1,905.46 | $3,890.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,348.96 / $3,019.95 / $3,162.28
| Professional | | $1,348.96 | $3,019.95 | $3,162.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,073.80 / $16,218.10 / $33,884.42
| Facility | | $4,073.80 | $16,218.10 | $33,884.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,148.15 / $1,949.84 / $3,890.45
| Professional | | $1,148.15 | $1,949.84 | $3,890.45 |