- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,174.90 / $1,949.84 / $7,943.28
| Facility | | $1,174.90 | $1,949.84 | $7,943.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,659.59 / $1,659.59 / $1,659.59
| Facility | | $1,659.59 | $1,659.59 | $1,659.59 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,122.02 / $1,548.82 / $1,862.09
| Professional | | $1,122.02 | $1,548.82 | $1,862.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $776.25 / $1,071.52 / $1,862.09
| Facility | | $776.25 | $1,071.52 | $1,862.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,122.02 / $1,513.56 / $1,584.89
| Facility | | $1,122.02 | $1,513.56 | $1,584.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $741.31 / $1,096.48 / $1,819.70
| Facility | | $741.31 | $1,096.48 | $1,819.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,073.80 / $4,073.80 / $4,073.80
| Facility | | $4,073.80 | $4,073.80 | $4,073.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,412.54 / $7,585.78 / $31,622.78
| Facility | | $1,412.54 | $7,585.78 | $31,622.78 |