- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,698.24 / $6,309.57 / $15,848.93
| Facility | | $1,698.24 | $6,309.57 | $15,848.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $48.98 / $165.96 / $354.81
| Professional | | $48.98 | $165.96 | $354.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $8,709.64 / $13,489.63 / $46,773.51
| Professional | | $8,709.64 | $13,489.63 | $46,773.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $851.14 / $851.14 / $851.14
| Professional | | $851.14 | $851.14 | $851.14 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,120.11 / $25,703.96 / $47,863.01
| Facility | | $9,120.11 | $25,703.96 | $47,863.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $47.86 / $70.79 / $812.83
| Professional | | $47.86 | $70.79 | $812.83 |