- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,467.37 / $4,466.84 / $23,988.33
| Facility | | $3,467.37 | $4,466.84 | $23,988.33 |
- 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
- $2,754.23 / $3,630.78 / $4,265.80
| Professional | | $2,754.23 | $3,630.78 | $4,265.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,737.80 / $2,754.23 / $4,466.84
| Facility | | $1,737.80 | $2,754.23 | $4,466.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,951.21 / $3,467.37 / $3,630.78
| Facility | | $2,951.21 | $3,467.37 | $3,630.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,737.80 / $2,691.53 / $3,890.45
| Facility | | $1,737.80 | $2,691.53 | $3,890.45 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $17,378.01 / $42,657.95 / $67,608.30
| Facility | | $17,378.01 | $42,657.95 | $67,608.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,311.31 / $26,302.68 / $56,234.13
| Facility | | $3,311.31 | $26,302.68 | $56,234.13 |