- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,691.53 / $10,964.78 / $18,197.01
| Facility | | $2,691.53 | $10,964.78 | $18,197.01 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,818.38 / $9,332.54 / $17,378.01
| Facility | | $2,818.38 | $9,332.54 | $17,378.01 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $562.34 / $1,659.59 / $3,715.35
| Facility | | $562.34 | $1,659.59 | $3,715.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $691.83 / $691.83 / $1,122.02
| Professional | | $691.83 | $691.83 | $1,122.02 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $794.33 / $1,258.93 / $2,041.74
| Facility | | $794.33 | $1,258.93 | $2,041.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $933.25 / $10,232.93 / $17,378.01
| Facility | | $933.25 | $10,232.93 | $17,378.01 |