- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,248.07 / $11,481.54 / $18,620.87
| Facility | | $5,248.07 | $11,481.54 | $18,620.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,168.69 / $5,754.40 / $14,125.38
| Facility | | $4,168.69 | $5,754.40 | $14,125.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,019.95 / $4,677.35 / $7,079.46
| Professional | | $3,019.95 | $4,677.35 | $7,079.46 |
- 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
- $1,288.25 / $1,778.28 / $2,754.23
| Professional | | $1,288.25 | $1,778.28 | $2,754.23 |