- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $954.99 / $2,454.71 / $5,011.87
| Facility | | $954.99 | $2,454.71 | $5,011.87 |
- 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 / $3,090.30 / $4,168.69
| Facility | | $3,090.30 | $3,090.30 | $4,168.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $9.12 / $588.84 / $3,981.07
| Professional | | $9.12 | $588.84 | $3,981.07 |
- 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
- $891.25 / $2,344.23 / $7,413.10
| Facility | | $891.25 | $2,344.23 | $7,413.10 |