- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,584.89 / $7,943.28 / $16,595.87
| Facility | | $1,584.89 | $7,943.28 | $16,595.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,344.23 / $5,623.41 / $10,715.19
| Facility | | $2,344.23 | $5,623.41 | $10,715.19 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $707.95 / $1,023.29 / $2,570.40
| Facility | | $707.95 | $1,023.29 | $2,570.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $794.33 / $794.33 / $1,380.38
| Professional | | $794.33 | $794.33 | $1,380.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $575.44 / $741.31 / $1,318.26
| Facility | | $575.44 | $741.31 | $1,318.26 |
- 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 |