- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $977.24 / $8,317.64 / $19,498.45
| Facility | | $977.24 | $8,317.64 | $19,498.45 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,748.98 / $14,791.08 / $15,848.93
| Facility | | $11,748.98 | $14,791.08 | $15,848.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $588.84 / $707.95 / $870.96
| Professional | | $588.84 | $707.95 | $870.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,819.70 / $1,819.70 / $1,819.70
| Professional | | $1,819.70 | $1,819.70 | $1,819.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $758.58 / $1,096.48 / $1,659.59
| Facility | | $758.58 | $1,096.48 | $1,659.59 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $724.44 / $1,096.48 / $7,413.10
| Facility | | $724.44 | $1,096.48 | $7,413.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,754.40 / $11,481.54 / $23,988.33
| Facility | | $5,754.40 | $11,481.54 | $23,988.33 |