- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,412.54 / $1,819.70 / $13,803.84
| Facility | | $1,412.54 | $1,819.70 | $13,803.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $851.14 / $851.14 / $851.14
| Facility | | $851.14 | $851.14 | $851.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $630.96 / $1,258.93 / $1,445.44
| Professional | | $630.96 | $1,258.93 | $1,445.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $741.31 / $1,096.48 / $2,290.87
| Facility | | $741.31 | $1,096.48 | $2,290.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,023.29 / $1,348.96 / $1,412.54
| Facility | | $1,023.29 | $1,348.96 | $1,412.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $691.83 / $1,096.48 / $1,778.28
| Facility | | $691.83 | $1,096.48 | $1,778.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,495.41 / $7,413.10 / $8,709.64
| Facility | | $5,495.41 | $7,413.10 | $8,709.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,995.26 / $9,549.93 / $12,882.50
| Facility | | $1,995.26 | $9,549.93 | $12,882.50 |