- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,474.42 / $2,747.00 / $7,920.26
| Facility | | $1,474.42 | $2,747.00 | $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
- $1,185.19 / $1,556.26 / $1,909.65
| Professional | | $1,185.19 | $1,556.26 | $1,909.65 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $834.61 / $1,336.03 / $2,055.76
| Facility | | $834.61 | $1,336.03 | $2,055.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $972.00 / $1,432.46 / $1,508.17
| Facility | | $972.00 | $1,432.46 | $1,508.17 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $872.11 / $1,503.34 / $2,055.76
| Facility | | $872.11 | $1,503.34 | $2,055.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,866.73 / $3,866.73 / $3,866.73
| Facility | | $3,866.73 | $3,866.73 | $3,866.73 |
- 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 |