- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,202.26 / $4,897.79 / $6,918.31
| Facility | | $1,202.26 | $4,897.79 | $6,918.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,630.27 / $4,570.88 / $7,079.46
| Facility | | $2,630.27 | $4,570.88 | $7,079.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $616.60 / $724.44 / $1,174.90
| Facility | | $616.60 | $724.44 | $1,174.90 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $234.42 / $354.81 / $3,548.13
| Facility | | $234.42 | $354.81 | $3,548.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $239.88 / $380.19 / $4,897.79
| Facility | | $239.88 | $380.19 | $4,897.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $281.84 / $501.19 / $776.25
| Professional | | $281.84 | $501.19 | $776.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,311.31 / $4,897.79 / $4,897.79
| Facility | | $3,311.31 | $4,897.79 | $4,897.79 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,884.03 / $3,801.89 / $6,606.93
| Facility | | $2,884.03 | $3,801.89 | $6,606.93 |