- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,265.80 / $14,125.38 / $28,183.83
| Facility | | $4,265.80 | $14,125.38 | $28,183.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,128.31 / $11,220.18 / $26,915.35
| Facility | | $8,128.31 | $11,220.18 | $26,915.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6,309.57 / $7,943.28 / $12,882.50
| Professional | | $6,309.57 | $7,943.28 | $12,882.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $912.01 / $2,344.23 / $6,456.54
| Facility | | $912.01 | $2,344.23 | $6,456.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,137.96 / $2,951.21 / $4,786.30
| Professional | | $2,137.96 | $2,951.21 | $4,786.30 |