- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,479.11 / $4,073.80 / $7,762.47
| Facility | | $1,479.11 | $4,073.80 | $7,762.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,174.90 / $1,380.38 / $2,238.72
| Professional | | $1,174.90 | $1,380.38 | $2,238.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,258.93 / $1,445.44 / $9,549.93
| Professional | | $1,258.93 | $1,445.44 | $9,549.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,122.02 / $1,445.44 / $3,715.35
| Professional | | $1,122.02 | $1,445.44 | $3,715.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,258.93 / $1,318.26 / $2,884.03
| Professional | | $1,258.93 | $1,318.26 | $2,884.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,311.31 / $7,943.28 / $26,915.35
| Facility | | $3,311.31 | $7,943.28 | $26,915.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,023.29 / $1,412.54 / $3,162.28
| Professional | | $1,023.29 | $1,412.54 | $3,162.28 |