- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,248.07 / $12,022.64 / $25,703.96
| Facility | | $5,248.07 | $12,022.64 | $25,703.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,801.89 / $5,128.61 / $12,589.25
| Facility | | $3,801.89 | $5,128.61 | $12,589.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,754.23 / $4,168.69 / $6,456.54
| Professional | | $2,754.23 | $4,168.69 | $6,456.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $851.14 / $2,187.76 / $6,606.93
| Facility | | $851.14 | $2,187.76 | $6,606.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,174.90 / $1,621.81 / $2,570.40
| Professional | | $1,174.90 | $1,621.81 | $2,570.40 |