- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,943.28 / $14,791.08 / $31,622.78
| Facility | | $7,943.28 | $14,791.08 | $31,622.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $112.20 / $446.68 / $1,230.27
| Professional | | $112.20 | $446.68 | $1,230.27 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,011.87 / $8,709.64 / $15,848.93
| Facility | | $5,011.87 | $8,709.64 | $15,848.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $34.67 / $537.03 / $616.60
| Facility | | $34.67 | $537.03 | $616.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $851.14 / $851.14 / $851.14
| Facility | | $851.14 | $851.14 | $851.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $30.20 / $30.20 / $30.20
| Professional | | $30.20 | $30.20 | $30.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,698.24 / $16,982.44 / $25,703.96
| Facility | | $1,698.24 | $16,982.44 | $25,703.96 |