- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $758.58 / $2,454.71 / $9,120.11
| Facility | | $758.58 | $2,454.71 | $9,120.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $43.65 / $741.31 / $38,904.51
| Professional | | $43.65 | $741.31 | $38,904.51 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,235.94 / $5,011.87 / $7,943.28
| Facility | | $3,235.94 | $5,011.87 | $7,943.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $89.13 / $602.56 / $1,659.59
| Facility | | $89.13 | $602.56 | $1,659.59 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $138.04 / $616.60 / $1,659.59
| Facility | | $138.04 | $616.60 | $1,659.59 |