- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,818.38 / $7,413.10 / $15,135.61
| Facility | | $2,818.38 | $7,413.10 | $15,135.61 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,412.54 / $1,949.84 / $4,786.30
| Facility | | $1,412.54 | $1,949.84 | $4,786.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,023.29 / $1,584.89 / $2,570.40
| Professional | | $1,023.29 | $1,584.89 | $2,570.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $562.34 / $1,905.46 / $6,309.57
| Facility | | $562.34 | $1,905.46 | $6,309.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $467.74 / $616.60 / $977.24
| Professional | | $467.74 | $616.60 | $977.24 |