- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,265.80 / $10,471.29 / $18,197.01
| Facility | | $4,265.80 | $10,471.29 | $18,197.01 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,365.16 / $18,197.01 / $34,673.69
| Facility | | $4,365.16 | $18,197.01 | $34,673.69 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $891.25 / $891.25 / $2,818.38
| Facility | | $891.25 | $891.25 | $2,818.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,691.53 / $2,691.53 / $3,801.89
| Professional | | $2,691.53 | $2,691.53 | $3,801.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,584.89 / $2,137.96 / $3,630.78
| Facility | | $1,584.89 | $2,137.96 | $3,630.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,677.35 / $20,417.38 / $25,703.96
| Facility | | $4,677.35 | $20,417.38 | $25,703.96 |