- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $758.58 / $7,943.28 / $14,454.40
| Facility | | $758.58 | $7,943.28 | $14,454.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13,489.63 / $17,378.01 / $33,884.42
| Facility | | $13,489.63 | $17,378.01 | $33,884.42 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $467.74 / $741.31 / $7,943.28
| Facility | | $467.74 | $741.31 | $7,943.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $912.01 / $954.99 / $1,318.26
| Professional | | $912.01 | $954.99 | $1,318.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,235.94 / $4,570.88 / $13,803.84
| Facility | | $3,235.94 | $4,570.88 | $13,803.84 |