- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,467.37 / $7,413.10 / $15,135.61
| Facility | | $3,467.37 | $7,413.10 | $15,135.61 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,238.72 / $3,162.28 / $7,585.78
| Facility | | $2,238.72 | $3,162.28 | $7,585.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,659.59 / $2,511.89 / $4,073.80
| Professional | | $1,659.59 | $2,511.89 | $4,073.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $602.56 / $1,862.09 / $6,309.57
| Facility | | $602.56 | $1,862.09 | $6,309.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $741.31 / $1,023.29 / $1,621.81
| Professional | | $741.31 | $1,023.29 | $1,621.81 |