- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,884.03 / $7,943.28 / $16,595.87
| Facility | | $2,884.03 | $7,943.28 | $16,595.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $34.67 / $562.34 / $4,168.69
| Facility | | $34.67 | $562.34 | $4,168.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,290.87 / $2,290.87 / $2,818.38
| Professional | | $2,290.87 | $2,290.87 | $2,818.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,089.30 / $3,019.95 / $5,011.87
| Facility | | $2,089.30 | $3,019.95 | $5,011.87 |
- 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 |