- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,479.11 / $7,244.36 / $9,772.37
| Facility | | $1,479.11 | $7,244.36 | $9,772.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,148.15 / $1,659.59 / $3,890.45
| Professional | | $1,148.15 | $1,659.59 | $3,890.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,230.27 / $4,466.84 / $11,748.98
| Professional | | $1,230.27 | $4,466.84 | $11,748.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,412.54 / $1,778.28 / $3,630.78
| Professional | | $1,412.54 | $1,778.28 | $3,630.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,047.13 / $1,202.26 / $2,691.53
| Professional | | $1,047.13 | $1,202.26 | $2,691.53 |
- 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
- $1,122.02 / $1,380.38 / $3,311.31
| Professional | | $1,122.02 | $1,380.38 | $3,311.31 |