- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,148.15 / $3,467.37 / $5,888.44
| Facility | | $1,148.15 | $3,467.37 | $5,888.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,570.88 / $8,128.31 / $8,128.31
| Facility | | $4,570.88 | $8,128.31 | $8,128.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,090.30 / $4,168.69 / $4,265.80
| Facility | | $3,090.30 | $4,168.69 | $4,265.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5.50 / $660.69 / $3,890.45
| Professional | | $5.50 | $660.69 | $3,890.45 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,162.28 / $3,162.28 / $3,162.28
| Facility | | $3,162.28 | $3,162.28 | $3,162.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,258.93 / $3,548.13 / $10,715.19
| Facility | | $1,258.93 | $3,548.13 | $10,715.19 |