- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,445.44 / $7,943.28 / $16,595.87
| Facility | | $1,445.44 | $7,943.28 | $16,595.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $34.67 / $562.34 / $2,089.30
| Facility | | $34.67 | $562.34 | $2,089.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,137.96 / $2,137.96 / $2,511.89
| Professional | | $2,137.96 | $2,137.96 | $2,511.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,202.26 / $1,737.80 / $2,754.23
| Facility | | $1,202.26 | $1,737.80 | $2,754.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $478.63 / $6,165.95 / $8,912.51
| Facility | | $478.63 | $6,165.95 | $8,912.51 |