- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $870.96 / $3,981.07 / $26,915.35
| Facility | | $870.96 | $3,981.07 | $26,915.35 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,248.07 / $14,454.40 / $22,387.21
| Facility | | $5,248.07 | $14,454.40 | $22,387.21 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $15,848.93 / $17,378.01 / $33,113.11
| Facility | | $15,848.93 | $17,378.01 | $33,113.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.24 / $338.84 / $457.09
| Professional | | $2.24 | $338.84 | $457.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $199.53 / $19,952.62 / $45,708.82
| Facility | | $199.53 | $19,952.62 | $45,708.82 |