- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,071.52 / $8,511.38 / $10,471.29
| Facility | | $1,071.52 | $8,511.38 | $10,471.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,862.09 / $1,862.09 / $2,691.53
| Facility | | $1,862.09 | $1,862.09 | $2,691.53 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $741.31 / $741.31 / $741.31
| Facility | | $741.31 | $741.31 | $741.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,202.26 / $1,202.26 / $1,698.24
| Professional | | $1,202.26 | $1,202.26 | $1,698.24 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $707.95 / $933.25 / $1,479.11
| Facility | | $707.95 | $933.25 | $1,479.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,454.71 / $9,332.54 / $14,454.40
| Facility | | $2,454.71 | $9,332.54 | $14,454.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,748.98 / $11,748.98 / $33,884.42
| Facility | | $11,748.98 | $11,748.98 | $33,884.42 |