- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,071.52 / $4,897.79 / $8,317.64
| Facility | | $1,071.52 | $4,897.79 | $8,317.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,090.30 / $3,981.07 / $4,466.84
| Facility | | $3,090.30 | $3,981.07 | $4,466.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $645.65 / $645.65 / $645.65
| Facility | | $645.65 | $645.65 | $645.65 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $588.84 / $741.31 / $891.25
| Professional | | $588.84 | $741.31 | $891.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $812.83 / $1,023.29 / $1,412.54
| Professional | | $812.83 | $1,023.29 | $1,412.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $562.34 / $741.31 / $1,202.26
| Facility | | $562.34 | $741.31 | $1,202.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $537.03 / $776.25 / $3,388.44
| Facility | | $537.03 | $776.25 | $3,388.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,737.80 / $3,311.31 / $5,754.40
| Facility | | $1,737.80 | $3,311.31 | $5,754.40 |