- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,737.80 / $9,120.11 / $16,595.87
| Facility | | $1,737.80 | $9,120.11 | $16,595.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,884.03 / $6,760.83 / $12,589.25
| Facility | | $2,884.03 | $6,760.83 | $12,589.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $891.25 / $891.25 / $1,096.48
| Facility | | $891.25 | $891.25 | $1,096.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,148.15 / $1,148.15 / $1,479.11
| Professional | | $1,148.15 | $1,148.15 | $1,479.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $630.96 / $912.01 / $1,412.54
| Facility | | $630.96 | $912.01 | $1,412.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,344.23 / $13,182.57 / $23,988.33
| Facility | | $2,344.23 | $13,182.57 | $23,988.33 |