- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $281.84 / $7,943.28 / $14,454.40
| Facility | | $281.84 | $7,943.28 | $14,454.40 |
- 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
- $186.21 / $302.00 / $7,943.28
| Facility | | $186.21 | $302.00 | $7,943.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $354.81 / $398.11 / $512.86
| Professional | | $354.81 | $398.11 | $512.86 |
- 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 |