- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $724.44 / $3,630.78 / $9,549.93
| Facility | | $724.44 | $3,630.78 | $9,549.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,748.98 / $19,054.61 / $26,302.68
| Facility | | $11,748.98 | $19,054.61 | $26,302.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $630.96 / $794.33 / $1,995.26
| Professional | | $630.96 | $794.33 | $1,995.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $891.25 / $1,122.02 / $1,621.81
| Professional | | $891.25 | $1,122.02 | $1,621.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $707.95 / $977.24 / $1,445.44
| Facility | | $707.95 | $977.24 | $1,445.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $630.96 / $912.01 / $5,248.07
| Facility | | $630.96 | $912.01 | $5,248.07 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,698.24 / $3,467.37 / $7,079.46
| Facility | | $1,698.24 | $3,467.37 | $7,079.46 |