- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,073.80 / $9,772.37 / $18,197.01
| Facility | | $4,073.80 | $9,772.37 | $18,197.01 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,884.03 / $3,890.45 / $9,549.93
| Facility | | $2,884.03 | $3,890.45 | $9,549.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,905.46 / $3,162.28 / $4,677.35
| Professional | | $1,905.46 | $3,162.28 | $4,677.35 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $891.25 / $2,187.76 / $6,606.93
| Facility | | $891.25 | $2,187.76 | $6,606.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $933.25 / $1,348.96 / $2,238.72
| Professional | | $933.25 | $1,348.96 | $2,238.72 |