- 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
- $1,174.90 / $1,621.81 / $3,981.07
| Facility | | $1,174.90 | $1,621.81 | $3,981.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $870.96 / $1,318.26 / $2,137.96
| Professional | | $870.96 | $1,318.26 | $2,137.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $549.54 / $1,905.46 / $6,309.57
| Facility | | $549.54 | $1,905.46 | $6,309.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $398.11 / $537.03 / $831.76
| Professional | | $398.11 | $537.03 | $831.76 |