- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $724.44 / $5,248.07 / $19,498.45
| Facility | | $724.44 | $5,248.07 | $19,498.45 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $43,651.58 / $52,480.75 / $54,954.09
| Facility | | $43,651.58 | $52,480.75 | $54,954.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $416.87 / $501.19 / $616.60
| Professional | | $416.87 | $501.19 | $616.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $691.83 / $870.96 / $1,202.26
| Professional | | $691.83 | $870.96 | $1,202.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $501.19 / $758.58 / $1,174.90
| Facility | | $501.19 | $758.58 | $1,174.90 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $467.74 / $676.08 / $30,902.95
| Facility | | $467.74 | $676.08 | $30,902.95 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13,182.57 / $39,810.72 / $66,069.34
| Facility | | $13,182.57 | $39,810.72 | $66,069.34 |