- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,202.26 / $9,120.11 / $18,197.01
| Facility | | $1,202.26 | $9,120.11 | $18,197.01 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,995.26 / $4,786.30 / $8,912.51
| Facility | | $1,995.26 | $4,786.30 | $8,912.51 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $776.25 / $812.83 / $2,570.40
| Facility | | $776.25 | $812.83 | $2,570.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $724.44 / $724.44 / $1,047.13
| Professional | | $724.44 | $724.44 | $1,047.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $446.68 / $602.56 / $1,047.13
| Facility | | $446.68 | $602.56 | $1,047.13 |
- 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 |