- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,122.02 / $4,265.80 / $12,302.69
| Facility | | $1,122.02 | $4,265.80 | $12,302.69 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $707.95 / $4,677.35 / $9,772.37
| Facility | | $707.95 | $4,677.35 | $9,772.37 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $371.54 / $724.44 / $1,862.09
| Facility | | $371.54 | $724.44 | $1,862.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $457.09 / $457.09 / $549.54
| Professional | | $457.09 | $457.09 | $549.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $380.19 / $602.56 / $1,047.13
| Facility | | $380.19 | $602.56 | $1,047.13 |
- 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 |