- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,238.72 / $6,760.83 / $12,882.50
| Facility | | $2,238.72 | $6,760.83 | $12,882.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,479.11 / $3,548.13 / $8,317.64
| Facility | | $1,479.11 | $3,548.13 | $8,317.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $562.34 / $575.44 / $1,380.38
| Facility | | $562.34 | $575.44 | $1,380.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $524.81 / $524.81 / $758.58
| Professional | | $524.81 | $524.81 | $758.58 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $323.59 / $436.52 / $758.58
| Facility | | $323.59 | $436.52 | $758.58 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,995.26 / $10,232.93 / $16,982.44
| Facility | | $1,995.26 | $10,232.93 | $16,982.44 |