- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,819.70 / $9,120.11 / $16,595.87
| Facility | | $1,819.70 | $9,120.11 | $16,595.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,570.40 / $6,165.95 / $11,481.54
| Facility | | $2,570.40 | $6,165.95 | $11,481.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $575.44 / $891.25 / $2,570.40
| Facility | | $575.44 | $891.25 | $2,570.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,412.54 / $1,412.54 / $1,621.81
| Professional | | $1,412.54 | $1,412.54 | $1,621.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $676.08 / $977.24 / $1,698.24
| Facility | | $676.08 | $977.24 | $1,698.24 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,344.23 / $13,182.57 / $23,442.29
| Facility | | $2,344.23 | $13,182.57 | $23,442.29 |