- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,241.58 / $2,747.27 / $7,920.26
| Facility | | $2,241.58 | $2,747.27 | $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
- $1,785.92 / $2,345.07 / $2,877.72
| Professional | | $1,785.92 | $2,345.07 | $2,877.72 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,228.49 / $2,013.14 / $3,097.98
| Facility | | $1,228.49 | $2,013.14 | $3,097.98 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,501.90 / $2,149.71 / $2,288.05
| Facility | | $1,501.90 | $2,149.71 | $2,288.05 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,268.99 / $2,271.50 / $3,097.98
| Facility | | $1,268.99 | $2,271.50 | $3,097.98 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,820.46 / $5,820.46 / $5,820.46
| Facility | | $5,820.46 | $5,820.46 | $5,820.46 |
- 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 |