- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,365.16 / $7,943.28 / $13,489.63
| Facility | | $4,365.16 | $7,943.28 | $13,489.63 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $34,673.69 / $44,668.36 / $87,096.36
| Facility | | $34,673.69 | $44,668.36 | $87,096.36 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $457.09 / $851.14 / $53,703.18
| Facility | | $457.09 | $851.14 | $53,703.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $870.96 / $912.01 / $1,230.27
| Professional | | $870.96 | $912.01 | $1,230.27 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,022.64 / $29,512.09 / $45,708.82
| Facility | | $12,022.64 | $29,512.09 | $45,708.82 |