- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,019.95 / $3,981.07 / $15,135.61
| Facility | | $3,019.95 | $3,981.07 | $15,135.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $52.48 / $61.66 / $223.87
| Professional | | $52.48 | $61.66 | $223.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,302.69 / $16,218.10 / $19,498.45
| Facility | | $12,302.69 | $16,218.10 | $19,498.45 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,466.84 / $8,128.31 / $19,054.61
| Facility | | $4,466.84 | $8,128.31 | $19,054.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $52.48 / $72.44 / $512.86
| Professional | | $52.48 | $72.44 | $512.86 |