- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $741.31 / $7,943.28 / $30,199.52
| Facility | | $741.31 | $7,943.28 | $30,199.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,882.50 / $16,595.87 / $32,359.37
| Facility | | $12,882.50 | $16,595.87 | $32,359.37 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $426.58 / $794.33 / $31,622.78
| Facility | | $426.58 | $794.33 | $31,622.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $794.33 / $851.14 / $1,148.15
| Professional | | $794.33 | $851.14 | $1,148.15 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,120.11 / $13,489.63 / $25,703.96
| Facility | | $9,120.11 | $13,489.63 | $25,703.96 |