- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,238.72 / $9,120.11 / $16,595.87
| Facility | | $2,238.72 | $9,120.11 | $16,595.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,949.84 / $4,073.80 / $7,762.47
| Facility | | $1,949.84 | $4,073.80 | $7,762.47 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $575.44 / $891.25 / $1,445.44
| Facility | | $575.44 | $891.25 | $1,445.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,348.96 / $1,348.96 / $1,949.84
| Professional | | $1,348.96 | $1,348.96 | $1,949.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $812.83 / $1,096.48 / $1,862.09
| Facility | | $812.83 | $1,096.48 | $1,862.09 |
- 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 |