- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,905.46 / $3,090.30 / $8,709.64
| Facility | | $1,905.46 | $3,090.30 | $8,709.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $489.78 / $575.44 / $3,311.31
| Facility | | $489.78 | $575.44 | $3,311.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,187.76 / $2,187.76 / $2,187.76
| Professional | | $2,187.76 | $2,187.76 | $2,187.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,621.81 / $2,290.87 / $3,630.78
| Facility | | $1,621.81 | $2,290.87 | $3,630.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $309.03 / $1,819.70 / $6,309.57
| Facility | | $309.03 | $1,819.70 | $6,309.57 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $56.23 / $17,378.01 / $17,378.01
| Facility | | $56.23 | $17,378.01 | $17,378.01 |