- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,311.31 / $10,471.29 / $18,197.01
| Facility | | $3,311.31 | $10,471.29 | $18,197.01 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $34.67 / $575.44 / $2,137.96
| Facility | | $34.67 | $575.44 | $2,137.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,621.81 / $1,621.81 / $1,905.46
| Professional | | $1,621.81 | $1,621.81 | $1,905.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,230.27 / $1,659.59 / $2,630.27
| Facility | | $1,230.27 | $1,659.59 | $2,630.27 |
- 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 |