- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,659.59 / $4,466.84 / $75,857.76
| Facility | | $1,659.59 | $4,466.84 | $75,857.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,715.35 / $6,025.60 / $7,762.47
| Facility | | $3,715.35 | $6,025.60 | $7,762.47 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,041.74 / $2,041.74 / $15,848.93
| Facility | | $2,041.74 | $2,041.74 | $15,848.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $199.53 / $323.59 / $3,311.31
| Professional | | $199.53 | $323.59 | $3,311.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,187.76 / $2,187.76 / $2,187.76
| Facility | | $2,187.76 | $2,187.76 | $2,187.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,659.59 / $3,162.28 / $44,668.36
| Facility | | $1,659.59 | $3,162.28 | $44,668.36 |