- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,071.52 / $7,943.28 / $14,454.40
| Facility | | $1,071.52 | $7,943.28 | $14,454.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $234.42 / $891.25 / $8,709.64
| Professional | | $234.42 | $891.25 | $8,709.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,073.80 / $5,370.32 / $10,471.29
| Facility | | $4,073.80 | $5,370.32 | $10,471.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,122.02 / $1,778.28 / $6,165.95
| Facility | | $1,122.02 | $1,778.28 | $6,165.95 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,148.15 / $1,819.70 / $6,309.57
| Facility | | $1,148.15 | $1,819.70 | $6,309.57 |