- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,621.81 / $9,120.11 / $16,595.87
| Facility | | $1,621.81 | $9,120.11 | $16,595.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,691.53 / $6,025.60 / $10,715.19
| Facility | | $2,691.53 | $6,025.60 | $10,715.19 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $575.44 / $891.25 / $5,754.40
| Facility | | $575.44 | $891.25 | $5,754.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,023.29 / $1,023.29 / $1,412.54
| Professional | | $1,023.29 | $1,023.29 | $1,412.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $602.56 / $812.83 / $1,318.26
| Facility | | $602.56 | $812.83 | $1,318.26 |
- 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 |