- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,348.96 / $6,760.83 / $16,595.87
| Facility | | $1,348.96 | $6,760.83 | $16,595.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,344.23 / $5,754.40 / $10,715.19
| Facility | | $2,344.23 | $5,754.40 | $10,715.19 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $575.44 / $851.14 / $891.25
| Facility | | $575.44 | $851.14 | $891.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $741.31 / $741.31 / $1,548.82
| Professional | | $741.31 | $741.31 | $1,548.82 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $478.63 / $741.31 / $1,288.25
| Facility | | $478.63 | $741.31 | $1,288.25 |
- 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 |