- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,778.28 / $9,120.11 / $16,595.87
| Facility | | $1,778.28 | $9,120.11 | $16,595.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,659.59 / $4,897.79 / $9,772.37
| Facility | | $1,659.59 | $4,897.79 | $9,772.37 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $562.34 / $1,122.02 / $1,862.09
| Facility | | $562.34 | $1,122.02 | $1,862.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $794.33 / $794.33 / $912.01
| Professional | | $794.33 | $794.33 | $912.01 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $645.65 / $831.76 / $1,380.38
| Facility | | $645.65 | $831.76 | $1,380.38 |
- 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 |