- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,862.09 / $8,912.51 / $16,595.87
| Facility | | $1,862.09 | $8,912.51 | $16,595.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,511.89 / $6,760.83 / $12,589.25
| Facility | | $2,511.89 | $6,760.83 | $12,589.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $575.44 / $891.25 / $1,202.26
| Facility | | $575.44 | $891.25 | $1,202.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,258.93 / $1,258.93 / $1,621.81
| Professional | | $1,258.93 | $1,258.93 | $1,621.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $691.83 / $977.24 / $1,548.82
| Facility | | $691.83 | $977.24 | $1,548.82 |
- 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 |