- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,370.32 / $12,302.69 / $26,915.35
| Facility | | $5,370.32 | $12,302.69 | $26,915.35 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,995.26 / $3,890.45 / $10,715.19
| Facility | | $1,995.26 | $3,890.45 | $10,715.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,511.89 / $3,548.13 / $5,128.61
| Professional | | $2,511.89 | $3,548.13 | $5,128.61 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $891.25 / $2,187.76 / $6,606.93
| Facility | | $891.25 | $2,187.76 | $6,606.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,174.90 / $1,698.24 / $2,754.23
| Professional | | $1,174.90 | $1,698.24 | $2,754.23 |