- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,981.07 / $3,981.07 / $4,786.30
| Facility | | $3,981.07 | $3,981.07 | $4,786.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $229.09 / $398.11 / $446.68
| Professional | | $229.09 | $398.11 | $446.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $40,738.03 / $48,977.88 / $53,703.18
| Facility | | $40,738.03 | $48,977.88 | $53,703.18 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,466.84 / $11,220.18 / $74,131.02
| Facility | | $4,466.84 | $11,220.18 | $74,131.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $380.19 / $524.81 / $812.83
| Professional | | $380.19 | $524.81 | $812.83 |