- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,630.78 / $7,244.36 / $13,182.57
| Facility | | $3,630.78 | $7,244.36 | $13,182.57 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,951.21 / $3,890.45 / $7,585.78
| Facility | | $2,951.21 | $3,890.45 | $7,585.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,318.26 / $1,318.26 / $1,318.26
| Facility | | $1,318.26 | $1,318.26 | $1,318.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $416.87 / $645.65 / $4,786.30
| Facility | | $416.87 | $645.65 | $4,786.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $758.58 / $891.25 / $1,202.26
| Professional | | $758.58 | $891.25 | $1,202.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,318.26 / $1,318.26 / $1,318.26
| Facility | | $1,318.26 | $1,318.26 | $1,318.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,995.26 / $4,365.16 / $8,128.31
| Facility | | $1,995.26 | $4,365.16 | $8,128.31 |