- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,148.15 / $2,884.03 / $5,888.44
| Facility | | $1,148.15 | $2,884.03 | $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 / $3,090.30 / $3,090.30
| Facility | | $3,090.30 | $3,090.30 | $3,090.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $891.25 / $1,380.38 / $4,786.30
| Professional | | $891.25 | $1,380.38 | $4,786.30 |
- 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
- $2,290.87 / $3,548.13 / $10,715.19
| Facility | | $2,290.87 | $3,548.13 | $10,715.19 |