- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,445.44 / $9,120.11 / $16,595.87
| Facility | | $1,445.44 | $9,120.11 | $16,595.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,630.78 / $8,511.38 / $15,848.93
| Facility | | $3,630.78 | $8,511.38 | $15,848.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $575.44 / $891.25 / $933.25
| Facility | | $575.44 | $891.25 | $933.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $870.96 / $870.96 / $1,258.93
| Professional | | $870.96 | $870.96 | $1,258.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $524.81 / $707.95 / $1,202.26
| Facility | | $524.81 | $707.95 | $1,202.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,630.78 / $17,378.01 / $26,302.68
| Facility | | $3,630.78 | $17,378.01 | $26,302.68 |