- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,513.56 / $9,120.11 / $16,595.87
| Facility | | $1,513.56 | $9,120.11 | $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
- $575.44 / $891.25 / $2,570.40
| Facility | | $575.44 | $891.25 | $2,570.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $977.24 / $977.24 / $1,318.26
| Professional | | $977.24 | $977.24 | $1,318.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $562.34 / $776.25 / $1,258.93
| Facility | | $562.34 | $776.25 | $1,258.93 |
- 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 |