- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $25,118.86 / $38,018.94 / $181,970.09
| Facility | | $25,118.86 | $38,018.94 | $181,970.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $77.62 / $151.36 / $199.53
| Facility | | $77.62 | $151.36 | $199.53 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $57.54 / $67.61 / $79.43
| Professional | | $57.54 | $67.61 | $79.43 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,023.29 / $10,232.93 / $11,748.98
| Facility | | $1,023.29 | $10,232.93 | $11,748.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10,232.93 / $10,232.93 / $10,715.19
| Professional | | $10,232.93 | $10,232.93 | $10,715.19 |