- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,653.88 / $3,257.83 / $7,920.26
| Facility | | $2,653.88 | $3,257.83 | $7,920.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,664.70 / $1,664.70 / $1,664.70
| Facility | | $1,664.70 | $1,664.70 | $1,664.70 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,114.27 / $2,776.23 / $3,396.30
| Professional | | $2,114.27 | $2,776.23 | $3,396.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,437.93 / $2,383.36 / $3,685.74
| Facility | | $1,437.93 | $2,383.36 | $3,685.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,773.32 / $2,571.46 / $2,718.86
| Facility | | $1,773.32 | $2,571.46 | $2,718.86 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,509.83 / $2,700.52 / $3,685.74
| Facility | | $1,509.83 | $2,700.52 | $3,685.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,922.47 / $6,922.47 / $6,922.47
| Facility | | $6,922.47 | $6,922.47 | $6,922.47 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,345.00 / $7,664.00 / $31,303.00
| Facility | | $1,345.00 | $7,664.00 | $31,303.00 |