- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,981.07 / $9,120.11 / $16,595.87
| Facility | | $3,981.07 | $9,120.11 | $16,595.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $34.67 / $575.44 / $5,888.44
| Facility | | $34.67 | $575.44 | $5,888.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,570.88 / $4,570.88 / $5,495.41
| Professional | | $4,570.88 | $4,570.88 | $5,495.41 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,235.94 / $4,466.84 / $7,244.36
| Facility | | $3,235.94 | $4,466.84 | $7,244.36 |
- 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 |