- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,548.82 / $7,244.36 / $16,595.87
| Facility | | $1,548.82 | $7,244.36 | $16,595.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,995.26 / $4,786.30 / $8,912.51
| Facility | | $1,995.26 | $4,786.30 | $8,912.51 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $501.19 / $776.25 / $5,754.40
| Facility | | $501.19 | $776.25 | $5,754.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,348.96 / $1,348.96 / $1,348.96
| Professional | | $1,348.96 | $1,348.96 | $1,348.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $575.44 / $870.96 / $1,513.56
| Facility | | $575.44 | $870.96 | $1,513.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,995.26 / $11,220.18 / $17,378.01
| Facility | | $1,995.26 | $11,220.18 | $17,378.01 |