- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,754.40 / $12,589.25 / $20,892.96
| Facility | | $5,754.40 | $12,589.25 | $20,892.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,230.27 / $1,698.24 / $4,073.80
| Facility | | $1,230.27 | $1,698.24 | $4,073.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $512.86 / $562.34 / $645.65
| Professional | | $512.86 | $562.34 | $645.65 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $691.83 / $2,089.30 / $6,456.54
| Facility | | $691.83 | $2,089.30 | $6,456.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $169.82 / $223.87 / $398.11
| Professional | | $169.82 | $223.87 | $398.11 |