- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,096.48 / $7,244.36 / $16,595.87
| Facility | | $1,096.48 | $7,244.36 | $16,595.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,995.26 / $4,786.30 / $9,120.11
| Facility | | $1,995.26 | $4,786.30 | $9,120.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $501.19 / $660.69 / $1,380.38
| Facility | | $501.19 | $660.69 | $1,380.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $758.58 / $758.58 / $954.99
| Professional | | $758.58 | $758.58 | $954.99 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $389.05 / $549.54 / $891.25
| Facility | | $389.05 | $549.54 | $891.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,995.26 / $10,232.93 / $16,982.44
| Facility | | $1,995.26 | $10,232.93 | $16,982.44 |