- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,148.15 / $1,445.44 / $13,182.57
| Facility | | $1,148.15 | $1,445.44 | $13,182.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $537.03 / $1,202.26 / $1,479.11
| Professional | | $537.03 | $1,202.26 | $1,479.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $776.25 / $1,148.15 / $7,943.28
| Facility | | $776.25 | $1,148.15 | $7,943.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $954.99 / $1,122.02 / $1,174.90
| Facility | | $954.99 | $1,122.02 | $1,174.90 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $676.08 / $977.24 / $1,513.56
| Facility | | $676.08 | $977.24 | $1,513.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,882.50 / $17,378.01 / $21,379.62
| Facility | | $12,882.50 | $17,378.01 | $21,379.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,019.95 / $20,892.96 / $26,302.68
| Facility | | $3,019.95 | $20,892.96 | $26,302.68 |