- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,548.82 / $5,011.87 / $77,624.71
| Facility | | $1,548.82 | $5,011.87 | $77,624.71 |
- 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
- $15,848.93 / $15,848.93 / $15,848.93
| Facility | | $15,848.93 | $15,848.93 | $15,848.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $22.91 / $1,584.89 / $2,238.72
| Professional | | $22.91 | $1,584.89 | $2,238.72 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,290.87 / $4,786.30 / $44,668.36
| Facility | | $2,290.87 | $4,786.30 | $44,668.36 |