- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,258.93 / $10,232.93 / $19,498.45
| Facility | | $1,258.93 | $10,232.93 | $19,498.45 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,754.23 / $6,456.54 / $12,022.64
| Facility | | $2,754.23 | $6,456.54 | $12,022.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $794.33 / $891.25 / $2,570.40
| Facility | | $794.33 | $891.25 | $2,570.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $794.33 / $794.33 / $1,096.48
| Professional | | $794.33 | $794.33 | $1,096.48 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $457.09 / $630.96 / $1,023.29
| Facility | | $457.09 | $630.96 | $1,023.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,344.23 / $13,182.57 / $23,442.29
| Facility | | $2,344.23 | $13,182.57 | $23,442.29 |