- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,090.30 / $3,981.07 / $23,988.33
| Facility | | $3,090.30 | $3,981.07 | $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
- $2,454.71 / $3,311.31 / $3,801.89
| Professional | | $2,454.71 | $3,311.31 | $3,801.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,548.82 / $2,454.71 / $3,890.45
| Facility | | $1,548.82 | $2,454.71 | $3,890.45 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,511.89 / $3,090.30 / $3,235.94
| Facility | | $2,511.89 | $3,090.30 | $3,235.94 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,548.82 / $2,398.83 / $3,467.37
| Facility | | $1,548.82 | $2,398.83 | $3,467.37 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $15,848.93 / $25,118.86 / $66,069.34
| Facility | | $15,848.93 | $25,118.86 | $66,069.34 |
- 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 |