- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $446.68 / $4,365.16 / $12,589.25
| Facility | | $446.68 | $4,365.16 | $12,589.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14,125.38 / $18,197.01 / $35,481.34
| Facility | | $14,125.38 | $18,197.01 | $35,481.34 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $263.03 / $501.19 / $13,803.84
| Facility | | $263.03 | $501.19 | $13,803.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $501.19 / $524.81 / $724.44
| Professional | | $501.19 | $524.81 | $724.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,786.30 / $7,413.10 / $10,964.78
| Facility | | $4,786.30 | $7,413.10 | $10,964.78 |