- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,068.34 / $3,754.34 / $7,920.26
| Facility | | $3,068.34 | $3,754.34 | $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
- $2,435.80 / $3,198.43 / $3,914.20
| Professional | | $2,435.80 | $3,198.43 | $3,914.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,688.95 / $2,745.82 / $4,246.64
| Facility | | $1,688.95 | $2,745.82 | $4,246.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,029.50 / $2,967.25 / $3,130.91
| Facility | | $2,029.50 | $2,967.25 | $3,130.91 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,736.83 / $3,122.94 / $4,246.64
| Facility | | $1,736.83 | $3,122.94 | $4,246.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,003.12 / $8,003.12 / $8,003.12
| Facility | | $8,003.12 | $8,003.12 | $8,003.12 |
- 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 |