- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,248.07 / $13,489.63 / $26,302.68
| Facility | | $5,248.07 | $13,489.63 | $26,302.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,570.88 / $6,165.95 / $15,135.61
| Facility | | $4,570.88 | $6,165.95 | $15,135.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,905.46 / $2,089.30 / $2,398.83
| Professional | | $1,905.46 | $2,089.30 | $2,398.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $870.96 / $2,187.76 / $7,079.46
| Facility | | $870.96 | $2,187.76 | $7,079.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,380.38 / $1,905.46 / $2,951.21
| Professional | | $1,380.38 | $1,905.46 | $2,951.21 |