- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,890.45 / $8,912.51 / $16,595.87
| Facility | | $3,890.45 | $8,912.51 | $16,595.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $34.67 / $562.34 / $5,623.41
| Facility | | $34.67 | $562.34 | $5,623.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,365.16 / $4,365.16 / $5,370.32
| Professional | | $4,365.16 | $4,365.16 | $5,370.32 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,162.28 / $4,365.16 / $6,918.31
| Facility | | $3,162.28 | $4,365.16 | $6,918.31 |
- 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 |