- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,318.26 / $10,232.93 / $20,417.38
| Facility | | $1,318.26 | $10,232.93 | $20,417.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,951.21 / $6,456.54 / $12,302.69
| Facility | | $2,951.21 | $6,456.54 | $12,302.69 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $575.44 / $870.96 / $2,570.40
| Facility | | $575.44 | $870.96 | $2,570.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $891.25 / $891.25 / $1,148.15
| Professional | | $891.25 | $891.25 | $1,148.15 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $489.78 / $691.83 / $1,348.96
| Facility | | $489.78 | $691.83 | $1,348.96 |
- 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 |