- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,700.17 / $3,291.03 / $7,920.26
| Facility | | $2,700.17 | $3,291.03 | $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
- $2,142.26 / $2,812.98 / $3,445.81
| Professional | | $2,142.26 | $2,812.98 | $3,445.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,448.20 / $2,414.90 / $3,748.68
| Facility | | $1,448.20 | $2,414.90 | $3,748.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,807.13 / $2,609.65 / $2,737.62
| Facility | | $1,807.13 | $2,609.65 | $2,737.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,516.86 / $2,756.05 / $3,748.68
| Facility | | $1,516.86 | $2,756.05 | $3,748.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,048.46 / $7,048.46 / $7,048.46
| Facility | | $7,048.46 | $7,048.46 | $7,048.46 |
- 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 |