- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,128.61 / $13,803.84 / $28,840.32
| Facility | | $5,128.61 | $13,803.84 | $28,840.32 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,511.89 / $3,467.37 / $8,511.38
| Facility | | $2,511.89 | $3,467.37 | $8,511.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,862.09 / $2,818.38 / $4,570.88
| Professional | | $1,862.09 | $2,818.38 | $4,570.88 |
- 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
- $831.76 / $1,174.90 / $1,819.70
| Professional | | $831.76 | $1,174.90 | $1,819.70 |