- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,380.38 / $6,025.60 / $16,595.87
| Facility | | $1,380.38 | $6,025.60 | $16,595.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $933.25 / $8,128.31 / $17,378.01
| Facility | | $933.25 | $8,128.31 | $17,378.01 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $501.19 / $870.96 / $1,778.28
| Facility | | $501.19 | $870.96 | $1,778.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $758.58 / $758.58 / $851.14
| Professional | | $758.58 | $758.58 | $851.14 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $501.19 / $707.95 / $1,096.48
| Facility | | $501.19 | $707.95 | $1,096.48 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $933.25 / $10,232.93 / $16,982.44
| Facility | | $933.25 | $10,232.93 | $16,982.44 |