- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,862.09 / $7,943.28 / $16,595.87
| Facility | | $1,862.09 | $7,943.28 | $16,595.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,691.53 / $5,754.40 / $10,715.19
| Facility | | $2,691.53 | $5,754.40 | $10,715.19 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $812.83 / $1,122.02 / $2,570.40
| Facility | | $812.83 | $1,122.02 | $2,570.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $758.58 / $758.58 / $1,096.48
| Professional | | $758.58 | $758.58 | $1,096.48 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $457.09 / $616.60 / $1,071.52
| Facility | | $457.09 | $616.60 | $1,071.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,995.26 / $11,220.18 / $16,982.44
| Facility | | $1,995.26 | $11,220.18 | $16,982.44 |