- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,202.26 / $1,778.28 / $2,398.83
| Facility | | $1,202.26 | $1,778.28 | $2,398.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $380.19 / $549.54 / $912.01
| Professional | | $380.19 | $549.54 | $912.01 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $33,884.42 / $40,738.03 / $54,954.09
| Facility | | $33,884.42 | $40,738.03 | $54,954.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,467.37 / $14,454.40 / $29,512.09
| Facility | | $3,467.37 | $14,454.40 | $29,512.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $602.56 / $891.25 / $1,318.26
| Professional | | $602.56 | $891.25 | $1,318.26 |