- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,290.87 / $7,244.36 / $16,595.87
| Facility | | $2,290.87 | $7,244.36 | $16,595.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $870.96 / $5,011.87 / $10,471.29
| Facility | | $870.96 | $5,011.87 | $10,471.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $537.03 / $1,445.44 / $2,137.96
| Facility | | $537.03 | $1,445.44 | $2,137.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,174.90 / $1,174.90 / $1,380.38
| Professional | | $1,174.90 | $1,174.90 | $1,380.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $831.76 / $1,148.15 / $1,819.70
| Facility | | $831.76 | $1,148.15 | $1,819.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,230.27 / $12,589.25 / $22,908.68
| Facility | | $1,230.27 | $12,589.25 | $22,908.68 |