- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $660.69 / $6,760.83 / $13,803.84
| Facility | | $660.69 | $6,760.83 | $13,803.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,772.37 / $12,302.69 / $17,782.79
| Facility | | $9,772.37 | $12,302.69 | $17,782.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $316.23 / $6,309.57 / $7,943.28
| Professional | | $316.23 | $6,309.57 | $7,943.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $588.84 / $5,754.40 / $15,135.61
| Professional | | $588.84 | $5,754.40 | $15,135.61 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $426.58 / $831.76 / $11,220.18
| Facility | | $426.58 | $831.76 | $11,220.18 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $346.74 / $537.03 / $19,952.62
| Facility | | $346.74 | $537.03 | $19,952.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,715.19 / $18,197.01 / $40,738.03
| Facility | | $10,715.19 | $18,197.01 | $40,738.03 |