- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,659.59 / $9,772.37 / $16,595.87
| Facility | | $1,659.59 | $9,772.37 | $16,595.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,862.09 / $4,365.16 / $8,709.64
| Facility | | $1,862.09 | $4,365.16 | $8,709.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $575.44 / $891.25 / $1,949.84
| Facility | | $575.44 | $891.25 | $1,949.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $691.83 / $691.83 / $1,445.44
| Professional | | $691.83 | $691.83 | $1,445.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $537.03 / $707.95 / $1,348.96
| Facility | | $537.03 | $707.95 | $1,348.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,479.11 / $6,760.83 / $10,471.29
| Facility | | $1,479.11 | $6,760.83 | $10,471.29 |