- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,168.69 / $10,715.19 / $20,892.96
| Facility | | $4,168.69 | $10,715.19 | $20,892.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,290.87 / $3,162.28 / $7,762.47
| Facility | | $2,290.87 | $3,162.28 | $7,762.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,659.59 / $2,570.40 / $4,073.80
| Professional | | $1,659.59 | $2,570.40 | $4,073.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $602.56 / $1,905.46 / $6,309.57
| Facility | | $602.56 | $1,905.46 | $6,309.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $758.58 / $1,023.29 / $1,621.81
| Professional | | $758.58 | $1,023.29 | $1,621.81 |