- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,370.32 / $6,918.31 / $13,803.84
| Facility | | $5,370.32 | $6,918.31 | $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
- $3,715.35 / $4,897.79 / $6,456.54
| Professional | | $3,715.35 | $4,897.79 | $6,456.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,691.53 / $4,265.80 / $6,760.83
| Facility | | $2,691.53 | $4,265.80 | $6,760.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,466.84 / $5,248.07 / $5,495.41
| Facility | | $4,466.84 | $5,248.07 | $5,495.41 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,691.53 / $4,265.80 / $6,165.95
| Facility | | $2,691.53 | $4,265.80 | $6,165.95 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,918.31 / $16,595.87 / $26,915.35
| Facility | | $6,918.31 | $16,595.87 | $26,915.35 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,884.03 / $17,782.79 / $31,622.78
| Facility | | $2,884.03 | $17,782.79 | $31,622.78 |