- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,706.14 / $3,955.04 / $5,496.04
| Facility | | $3,706.14 | $3,955.04 | $5,496.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $229.18 / $377.35 / $402.12
| Professional | | $229.18 | $377.35 | $402.12 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $39,186.76 / $47,491.67 / $51,223.06
| Facility | | $39,186.76 | $47,491.67 | $51,223.06 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,505.00 / $10,745.00 / $74,646.00
| Facility | | $4,505.00 | $10,745.00 | $74,646.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $387.29 / $523.98 / $851.27
| Professional | | $387.29 | $523.98 | $851.27 |