- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $416.87 / $7,943.28 / $14,454.40
| Facility | | $416.87 | $7,943.28 | $14,454.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,549.93 / $12,589.25 / $24,547.09
| Facility | | $9,549.93 | $12,589.25 | $24,547.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $213.80 / $354.81 / $2,089.30
| Facility | | $213.80 | $354.81 | $2,089.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $436.52 / $537.03 / $741.31
| Professional | | $436.52 | $537.03 | $741.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,089.30 / $6,456.54 / $8,912.51
| Facility | | $2,089.30 | $6,456.54 | $8,912.51 |