- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,737.80 / $4,570.88 / $7,762.47
| Facility | | $1,737.80 | $4,570.88 | $7,762.47 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,370.32 / $9,332.54 / $10,964.78
| Facility | | $5,370.32 | $9,332.54 | $10,964.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,073.80 / $16,982.44 / $17,782.79
| Facility | | $4,073.80 | $16,982.44 | $17,782.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $12.02 / $660.69 / $3,890.45
| Professional | | $12.02 | $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
- $1,445.44 / $4,073.80 / $12,022.64
| Facility | | $1,445.44 | $4,073.80 | $12,022.64 |