- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,778.28 / $2,344.23 / $15,848.93
| Facility | | $1,778.28 | $2,344.23 | $15,848.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,174.90 / $1,174.90 / $1,174.90
| Facility | | $1,174.90 | $1,174.90 | $1,174.90 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,412.54 / $1,862.09 / $2,187.76
| Professional | | $1,412.54 | $1,862.09 | $2,187.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $891.25 / $1,380.38 / $2,137.96
| Facility | | $891.25 | $1,380.38 | $2,137.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,380.38 / $1,659.59 / $1,819.70
| Facility | | $1,380.38 | $1,659.59 | $1,819.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $912.01 / $1,318.26 / $1,949.84
| Facility | | $912.01 | $1,318.26 | $1,949.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,762.47 / $10,232.93 / $12,302.69
| Facility | | $7,762.47 | $10,232.93 | $12,302.69 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,137.96 / $12,882.50 / $26,302.68
| Facility | | $2,137.96 | $12,882.50 | $26,302.68 |