- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,819.70 / $9,120.11 / $16,595.87
| Facility | | $1,819.70 | $9,120.11 | $16,595.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,786.30 / $10,715.19 / $19,952.62
| Facility | | $4,786.30 | $10,715.19 | $19,952.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $575.44 / $891.25 / $1,148.15
| Facility | | $575.44 | $891.25 | $1,148.15 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,174.90 / $1,174.90 / $1,548.82
| Professional | | $1,174.90 | $1,174.90 | $1,548.82 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $660.69 / $933.25 / $1,479.11
| Facility | | $660.69 | $933.25 | $1,479.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,677.35 / $20,417.38 / $25,703.96
| Facility | | $4,677.35 | $20,417.38 | $25,703.96 |