- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,148.15 / $5,128.61 / $7,762.47
| Facility | | $1,148.15 | $5,128.61 | $7,762.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $954.99 / $1,096.48 / $1,230.27
| Professional | | $954.99 | $1,096.48 | $1,230.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $13,803.84 / $17,378.01 / $35,481.34
| Professional | | $13,803.84 | $17,378.01 | $35,481.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,071.52 / $1,318.26 / $3,019.95
| Professional | | $1,071.52 | $1,318.26 | $3,019.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,122.02 / $2,187.76 / $2,454.71
| Professional | | $1,122.02 | $2,187.76 | $2,454.71 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,897.79 / $13,489.63 / $63,095.73
| Facility | | $4,897.79 | $13,489.63 | $63,095.73 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $776.25 / $1,412.54 / $3,019.95
| Professional | | $776.25 | $1,412.54 | $3,019.95 |