- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $660.69 / $5,888.44 / $30,902.95
| Facility | | $660.69 | $5,888.44 | $30,902.95 |
- 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
- $371.54 / $446.68 / $549.54
| Professional | | $371.54 | $446.68 | $549.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $616.60 / $776.25 / $1,071.52
| Professional | | $616.60 | $776.25 | $1,071.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $457.09 / $676.08 / $1,047.13
| Facility | | $457.09 | $676.08 | $1,047.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $426.58 / $616.60 / $30,902.95
| Facility | | $426.58 | $616.60 | $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 |