- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,230.27 / $8,709.64 / $16,595.87
| Facility | | $1,230.27 | $8,709.64 | $16,595.87 |
- 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
- $575.44 / $776.25 / $1,513.56
| Facility | | $575.44 | $776.25 | $1,513.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $691.83 / $691.83 / $1,047.13
| Professional | | $691.83 | $691.83 | $1,047.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $446.68 / $602.56 / $977.24
| Facility | | $446.68 | $602.56 | $977.24 |
- 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 |