- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,162.28 / $4,168.69 / $15,848.93
| Facility | | $3,162.28 | $4,168.69 | $15,848.93 |
- 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
- $2,511.89 / $3,311.31 / $3,801.89
| Professional | | $2,511.89 | $3,311.31 | $3,801.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,584.89 / $2,511.89 / $3,981.07
| Facility | | $1,584.89 | $2,511.89 | $3,981.07 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,398.83 / $3,090.30 / $3,311.31
| Facility | | $2,398.83 | $3,090.30 | $3,311.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,584.89 / $2,454.71 / $3,467.37
| Facility | | $1,584.89 | $2,454.71 | $3,467.37 |
- 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
- $3,019.95 / $20,892.96 / $31,622.78
| Facility | | $3,019.95 | $20,892.96 | $31,622.78 |