- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,318.26 / $7,943.28 / $16,595.87
| Facility | | $1,318.26 | $7,943.28 | $16,595.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $34.67 / $575.44 / $1,905.46
| Facility | | $34.67 | $575.44 | $1,905.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,380.38 / $1,380.38 / $1,659.59
| Professional | | $1,380.38 | $1,380.38 | $1,659.59 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,096.48 / $1,479.11 / $2,344.23
| Facility | | $1,096.48 | $1,479.11 | $2,344.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,089.30 / $19,498.45 / $24,547.09
| Facility | | $2,089.30 | $19,498.45 | $24,547.09 |