- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,511.89 / $7,244.36 / $16,595.87
| Facility | | $2,511.89 | $7,244.36 | $16,595.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,818.38 / $6,606.93 / $12,882.50
| Facility | | $2,818.38 | $6,606.93 | $12,882.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $371.54 / $1,584.89 / $1,862.09
| Facility | | $371.54 | $1,584.89 | $1,862.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,148.15 / $1,148.15 / $1,348.96
| Professional | | $1,148.15 | $1,148.15 | $1,348.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $912.01 / $1,230.27 / $1,995.26
| Facility | | $912.01 | $1,230.27 | $1,995.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,230.27 / $12,589.25 / $22,387.21
| Facility | | $1,230.27 | $12,589.25 | $22,387.21 |