- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,778.28 / $10,471.29 / $18,197.01
| Facility | | $1,778.28 | $10,471.29 | $18,197.01 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,754.23 / $6,760.83 / $12,589.25
| Facility | | $2,754.23 | $6,760.83 | $12,589.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $707.95 / $1,096.48 / $2,570.40
| Facility | | $707.95 | $1,096.48 | $2,570.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,071.52 / $1,071.52 / $1,513.56
| Professional | | $1,071.52 | $1,071.52 | $1,513.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $645.65 / $870.96 / $1,445.44
| Facility | | $645.65 | $870.96 | $1,445.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,344.23 / $13,182.57 / $23,442.29
| Facility | | $2,344.23 | $13,182.57 | $23,442.29 |