- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $912.01 / $1,659.59 / $7,943.28
| Facility | | $912.01 | $1,659.59 | $7,943.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $851.14 / $851.14 / $851.14
| Facility | | $851.14 | $851.14 | $851.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,000.00 / $1,318.26 / $1,584.89
| Professional | | $1,000.00 | $1,318.26 | $1,584.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $660.69 / $1,047.13 / $1,621.81
| Facility | | $660.69 | $1,047.13 | $1,621.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,096.48 / $1,288.25 / $1,348.96
| Facility | | $1,096.48 | $1,288.25 | $1,348.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $660.69 / $1,047.13 / $1,548.82
| Facility | | $660.69 | $1,047.13 | $1,548.82 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $17,378.01 / $42,657.95 / $67,608.30
| Facility | | $17,378.01 | $42,657.95 | $67,608.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,311.31 / $25,703.96 / $52,480.75
| Facility | | $3,311.31 | $25,703.96 | $52,480.75 |