- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,737.80 / $2,344.23 / $7,943.28
| Facility | | $1,737.80 | $2,344.23 | $7,943.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,187.76 / $2,187.76 / $2,187.76
| Facility | | $2,187.76 | $2,187.76 | $2,187.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,479.11 / $1,905.46 / $2,238.72
| Professional | | $1,479.11 | $1,905.46 | $2,238.72 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $870.96 / $1,318.26 / $2,137.96
| Facility | | $870.96 | $1,318.26 | $2,137.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,230.27 / $1,698.24 / $1,862.09
| Facility | | $1,230.27 | $1,698.24 | $1,862.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $891.25 / $1,288.25 / $2,041.74
| Facility | | $891.25 | $1,288.25 | $2,041.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $16,982.44 / $22,387.21 / $28,183.83
| Facility | | $16,982.44 | $22,387.21 | $28,183.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,019.95 / $20,892.96 / $31,622.78
| Facility | | $3,019.95 | $20,892.96 | $31,622.78 |