- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,995.26 / $6,309.57 / $18,620.87
| Facility | | $1,995.26 | $6,309.57 | $18,620.87 |
- 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
- $1,479.11 / $1,949.84 / $2,398.83
| Professional | | $1,479.11 | $1,949.84 | $2,398.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $933.25 / $1,659.59 / $8,511.38
| Facility | | $933.25 | $1,659.59 | $8,511.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,621.81 / $1,905.46 / $1,995.26
| Facility | | $1,621.81 | $1,905.46 | $1,995.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $977.24 / $1,584.89 / $2,398.83
| Facility | | $977.24 | $1,584.89 | $2,398.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $16,982.44 / $22,387.21 / $27,542.29
| Facility | | $16,982.44 | $22,387.21 | $27,542.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,019.95 / $20,892.96 / $31,622.78
| Facility | | $3,019.95 | $20,892.96 | $31,622.78 |