- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,888.44 / $12,302.69 / $28,840.32
| Facility | | $5,888.44 | $12,302.69 | $28,840.32 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,949.84 / $4,466.84 / $11,481.54
| Facility | | $1,949.84 | $4,466.84 | $11,481.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,630.27 / $3,801.89 / $5,623.41
| Professional | | $2,630.27 | $3,801.89 | $5,623.41 |
- 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
- $1,148.15 / $1,659.59 / $2,691.53
| Professional | | $1,148.15 | $1,659.59 | $2,691.53 |