- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,445.44 / $5,495.41 / $7,762.47
| Facility | | $1,445.44 | $5,495.41 | $7,762.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,288.25 / $1,445.44 / $4,168.69
| Professional | | $1,288.25 | $1,445.44 | $4,168.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,479.11 / $3,715.35 / $9,120.11
| Professional | | $1,479.11 | $3,715.35 | $9,120.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,412.54 / $1,949.84 / $3,890.45
| Professional | | $1,412.54 | $1,949.84 | $3,890.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,258.93 / $2,818.38 / $3,162.28
| Professional | | $1,258.93 | $2,818.38 | $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
- $1,288.25 / $1,995.26 / $3,801.89
| Professional | | $1,288.25 | $1,995.26 | $3,801.89 |