- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,801.89 / $9,332.54 / $17,378.01
| Facility | | $3,801.89 | $9,332.54 | $17,378.01 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,737.80 / $4,073.80 / $11,481.54
| Facility | | $1,737.80 | $4,073.80 | $11,481.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,238.72 / $3,801.89 / $6,025.60
| Professional | | $2,238.72 | $3,801.89 | $6,025.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,884.03 / $6,165.95 / $14,125.38
| Facility | | $2,884.03 | $6,165.95 | $14,125.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,122.02 / $1,548.82 / $2,754.23
| Professional | | $1,122.02 | $1,548.82 | $2,754.23 |