- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,467.37 / $3,715.35 / $3,981.07
| Facility | | $3,467.37 | $3,715.35 | $3,981.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $588.84 / $707.95 / $1,230.27
| Professional | | $588.84 | $707.95 | $1,230.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $660.69 / $870.96 / $1,288.25
| Professional | | $660.69 | $870.96 | $1,288.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $676.08 / $13,182.57 / $13,182.57
| Facility | | $676.08 | $13,182.57 | $13,182.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $549.54 / $1,047.13 / $1,621.81
| Professional | | $549.54 | $1,047.13 | $1,621.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,412.54 / $6,309.57 / $13,489.63
| Facility | | $1,412.54 | $6,309.57 | $13,489.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $575.44 / $812.83 / $1,445.44
| Professional | | $575.44 | $812.83 | $1,445.44 |