- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $27,662.52 / $51,027.60 / $80,491.25
| Facility | | $27,662.52 | $51,027.60 | $80,491.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $271.79 / $302.79 / $615.71
| Facility | | $271.79 | $302.79 | $615.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $40,781.69 / $40,781.69 / $40,781.69
| Professional | | $40,781.69 | $40,781.69 | $40,781.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $30.00 / $30.00 / $30.00
| Professional | | $30.00 | $30.00 | $30.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $288.79 / $434.79 / $788.82
| Professional | | $288.79 | $434.79 | $788.82 |