- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,819.70 / $10,232.93 / $20,417.38
| Facility | | $1,819.70 | $10,232.93 | $20,417.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,606.93 / $13,489.63 / $26,302.68
| Facility | | $6,606.93 | $13,489.63 | $26,302.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $891.25 / $1,096.48 / $5,754.40
| Facility | | $891.25 | $1,096.48 | $5,754.40 |
- 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 / $891.25 / $1,445.44
| Facility | | $630.96 | $891.25 | $1,445.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,630.78 / $17,378.01 / $26,302.68
| Facility | | $3,630.78 | $17,378.01 | $26,302.68 |