- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,754.23 / $5,370.32 / $26,915.35
| Facility | | $2,754.23 | $5,370.32 | $26,915.35 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,630.78 / $5,011.87 / $12,302.69
| Facility | | $3,630.78 | $5,011.87 | $12,302.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,513.56 / $1,659.59 / $1,949.84
| Professional | | $1,513.56 | $1,659.59 | $1,949.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,698.24 / $7,244.36 / $18,197.01
| Facility | | $1,698.24 | $7,244.36 | $18,197.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,230.27 / $1,819.70 / $2,884.03
| Professional | | $1,230.27 | $1,819.70 | $2,884.03 |