- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,778.28 / $7,244.36 / $16,595.87
| Facility | | $1,778.28 | $7,244.36 | $16,595.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $870.96 / $6,456.54 / $13,182.57
| Facility | | $870.96 | $6,456.54 | $13,182.57 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $501.19 / $1,148.15 / $3,630.78
| Facility | | $501.19 | $1,148.15 | $3,630.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $912.01 / $912.01 / $1,071.52
| Professional | | $912.01 | $912.01 | $1,071.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $660.69 / $891.25 / $1,445.44
| Facility | | $660.69 | $891.25 | $1,445.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,230.27 / $12,589.25 / $23,988.33
| Facility | | $1,230.27 | $12,589.25 | $23,988.33 |