- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,584.89 / $7,244.36 / $16,595.87
| Facility | | $1,584.89 | $7,244.36 | $16,595.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,698.24 / $4,073.80 / $7,762.47
| Facility | | $1,698.24 | $4,073.80 | $7,762.47 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $501.19 / $776.25 / $1,513.56
| Facility | | $501.19 | $776.25 | $1,513.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $912.01 / $912.01 / $1,380.38
| Professional | | $912.01 | $912.01 | $1,380.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $562.34 / $776.25 / $1,288.25
| Facility | | $562.34 | $776.25 | $1,288.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,995.26 / $10,964.78 / $16,982.44
| Facility | | $1,995.26 | $10,964.78 | $16,982.44 |