- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,890.45 / $9,772.37 / $18,197.01
| Facility | | $3,890.45 | $9,772.37 | $18,197.01 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,370.32 / $7,585.78 / $17,782.79
| Facility | | $5,370.32 | $7,585.78 | $17,782.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,238.72 / $2,454.71 / $2,818.38
| Professional | | $2,238.72 | $2,454.71 | $2,818.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,995.26 / $4,897.79 / $11,220.18
| Facility | | $1,995.26 | $4,897.79 | $11,220.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $707.95 / $912.01 / $1,479.11
| Professional | | $707.95 | $912.01 | $1,479.11 |