- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,438.26 / $3,706.14 / $4,026.21
| Facility | | $3,438.26 | $3,706.14 | $4,026.21 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,371.27 / $1,515.69 / $1,536.18
| Professional | | $1,371.27 | $1,515.69 | $1,536.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,388.58 / $1,633.62 / $2,598.30
| Professional | | $1,388.58 | $1,633.62 | $2,598.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,098.28 / $1,629.71 / $2,878.13
| Professional | | $1,098.28 | $1,629.71 | $2,878.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,146.00 / $5,164.00 / $9,622.00
| Facility | | $3,146.00 | $5,164.00 | $9,622.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,000.30 / $1,422.29 / $2,158.61
| Professional | | $1,000.30 | $1,422.29 | $2,158.61 |