- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,238.72 / $2,951.21 / $13,182.57
| Facility | | $2,238.72 | $2,951.21 | $13,182.57 |
- 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
- $1,698.24 / $2,238.72 / $2,754.23
| Professional | | $1,698.24 | $2,238.72 | $2,754.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $741.31 / $1,659.59 / $2,818.38
| Facility | | $741.31 | $1,659.59 | $2,818.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,548.82 / $2,137.96 / $2,290.87
| Facility | | $1,548.82 | $2,137.96 | $2,290.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $645.65 / $1,584.89 / $2,398.83
| Facility | | $645.65 | $1,584.89 | $2,398.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $33,884.42 / $42,657.95 / $53,703.18
| Facility | | $33,884.42 | $42,657.95 | $53,703.18 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,137.96 / $13,182.57 / $56,234.13
| Facility | | $2,137.96 | $13,182.57 | $56,234.13 |