- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,949.84 / $9,772.37 / $16,595.87
| Facility | | $1,949.84 | $9,772.37 | $16,595.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,698.24 / $4,168.69 / $7,762.47
| Facility | | $1,698.24 | $4,168.69 | $7,762.47 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $575.44 / $891.25 / $1,513.56
| Facility | | $575.44 | $891.25 | $1,513.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,148.15 / $1,148.15 / $1,698.24
| Professional | | $1,148.15 | $1,148.15 | $1,698.24 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $707.95 / $933.25 / $1,584.89
| Facility | | $707.95 | $933.25 | $1,584.89 |
- 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 |