- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,348.96 / $1,737.80 / $13,182.57
| Facility | | $1,348.96 | $1,737.80 | $13,182.57 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,187.76 / $2,187.76 / $2,187.76
| Facility | | $2,187.76 | $2,187.76 | $2,187.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,000.00 / $1,348.96 / $1,621.81
| Professional | | $1,000.00 | $1,348.96 | $1,621.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $630.96 / $1,000.00 / $2,041.74
| Facility | | $630.96 | $1,000.00 | $2,041.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,096.48 / $1,318.26 / $1,348.96
| Facility | | $1,096.48 | $1,318.26 | $1,348.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $676.08 / $1,047.13 / $1,659.59
| Facility | | $676.08 | $1,047.13 | $1,659.59 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,606.93 / $8,912.51 / $10,715.19
| Facility | | $6,606.93 | $8,912.51 | $10,715.19 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,995.26 / $9,549.93 / $12,882.50
| Facility | | $1,995.26 | $9,549.93 | $12,882.50 |