- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,754.40 / $8,511.38 / $40,738.03
| Facility | | $5,754.40 | $8,511.38 | $40,738.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $33,884.42 / $44,668.36 / $87,096.36
| Facility | | $33,884.42 | $44,668.36 | $87,096.36 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $457.09 / $870.96 / $53,703.18
| Facility | | $457.09 | $870.96 | $53,703.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $870.96 / $912.01 / $1,258.93
| Professional | | $870.96 | $912.01 | $1,258.93 |
- 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 |