- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,041.74 / $7,244.36 / $16,595.87
| Facility | | $2,041.74 | $7,244.36 | $16,595.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,698.24 / $4,365.16 / $8,709.64
| Facility | | $1,698.24 | $4,365.16 | $8,709.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,318.26 / $1,737.80 / $18,620.87
| Facility | | $1,318.26 | $1,737.80 | $18,620.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,258.93 / $1,258.93 / $1,778.28
| Professional | | $1,258.93 | $1,258.93 | $1,778.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $741.31 / $954.99 / $1,659.59
| Facility | | $741.31 | $954.99 | $1,659.59 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,677.35 / $20,417.38 / $25,703.96
| Facility | | $4,677.35 | $20,417.38 | $25,703.96 |