- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,047.13 / $9,120.11 / $16,595.87
| Facility | | $1,047.13 | $9,120.11 | $16,595.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,698.24 / $4,073.80 / $7,585.78
| Facility | | $1,698.24 | $4,073.80 | $7,585.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $575.44 / $691.83 / $1,513.56
| Facility | | $575.44 | $691.83 | $1,513.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $616.60 / $616.60 / $891.25
| Professional | | $616.60 | $616.60 | $891.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $380.19 / $524.81 / $851.14
| Facility | | $380.19 | $524.81 | $851.14 |
- 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 |