- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $346.74 / $7,943.28 / $14,454.40
| Facility | | $346.74 | $7,943.28 | $14,454.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,964.78 / $14,454.40 / $28,183.83
| Facility | | $10,964.78 | $14,454.40 | $28,183.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $213.80 / $338.84 / $4,365.16
| Facility | | $213.80 | $338.84 | $4,365.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $416.87 / $446.68 / $602.56
| Professional | | $416.87 | $446.68 | $602.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,096.48 / $1,548.82 / $4,570.88
| Facility | | $1,096.48 | $1,548.82 | $4,570.88 |