- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,265.80 / $6,025.60 / $9,772.37
| Facility | | $4,265.80 | $6,025.60 | $9,772.37 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,698.24 / $3,981.07 / $7,762.47
| Facility | | $1,698.24 | $3,981.07 | $7,762.47 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $501.19 / $724.44 / $1,513.56
| Facility | | $501.19 | $724.44 | $1,513.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $616.60 / $616.60 / $933.25
| Professional | | $616.60 | $616.60 | $933.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $407.38 / $537.03 / $891.25
| Facility | | $407.38 | $537.03 | $891.25 |
- 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 |