- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $776.25 / $2,454.71 / $5,011.87
| Facility | | $776.25 | $2,454.71 | $5,011.87 |
- 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
- $2,884.03 / $3,890.45 / $4,073.80
| Facility | | $2,884.03 | $3,890.45 | $4,073.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $154.88 / $741.31 / $3,019.95
| Professional | | $154.88 | $741.31 | $3,019.95 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,019.95 / $3,019.95 / $3,019.95
| Facility | | $3,019.95 | $3,019.95 | $3,019.95 |
- 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 |