- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $263.03 / $263.03 / $77,624.71
| Facility | | $263.03 | $263.03 | $77,624.71 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,890.45 / $4,265.80 / $7,244.36
| Facility | | $3,890.45 | $4,265.80 | $7,244.36 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $51,286.14 / $51,286.14 / $51,286.14
| Facility | | $51,286.14 | $51,286.14 | $51,286.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5.62 / $223.87 / $371.54
| Professional | | $5.62 | $223.87 | $371.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $724.44 / $2,290.87 / $6,456.54
| Facility | | $724.44 | $2,290.87 | $6,456.54 |