- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,621.81 / $9,120.11 / $16,595.87
| Facility | | $1,621.81 | $9,120.11 | $16,595.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $602.56 / $1,047.13 / $1,819.70
| Facility | | $602.56 | $1,047.13 | $1,819.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $575.44 / $575.44 / $1,949.84
| Facility | | $575.44 | $575.44 | $1,949.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $933.25 / $933.25 / $933.25
| Professional | | $933.25 | $933.25 | $933.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $588.84 / $691.83 / $954.99
| Facility | | $588.84 | $691.83 | $954.99 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,698.24 / $6,760.83 / $10,471.29
| Facility | | $1,698.24 | $6,760.83 | $10,471.29 |