- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,632.69 / $3,229.24 / $7,920.26
| Facility | | $2,632.69 | $3,229.24 | $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
- $2,096.04 / $2,752.29 / $3,370.52
| Professional | | $2,096.04 | $2,752.29 | $3,370.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,447.79 / $2,362.80 / $3,664.45
| Facility | | $1,447.79 | $2,362.80 | $3,664.45 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,673.14 / $2,553.35 / $2,691.39
| Facility | | $1,673.14 | $2,553.35 | $2,691.39 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,552.04 / $2,693.70 / $3,664.45
| Facility | | $1,552.04 | $2,693.70 | $3,664.45 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,906.46 / $6,906.46 / $6,906.46
| Facility | | $6,906.46 | $6,906.46 | $6,906.46 |
- 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 |