- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,511.89 / $3,311.31 / $23,988.33
| Facility | | $2,511.89 | $3,311.31 | $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
- $2,041.74 / $2,691.53 / $3,162.28
| Professional | | $2,041.74 | $2,691.53 | $3,162.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,258.93 / $1,995.26 / $3,162.28
| Facility | | $1,258.93 | $1,995.26 | $3,162.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,995.26 / $2,511.89 / $2,630.27
| Facility | | $1,995.26 | $2,511.89 | $2,630.27 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,288.25 / $1,949.84 / $2,884.03
| Facility | | $1,288.25 | $1,949.84 | $2,884.03 |
- 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 / $75,857.76
| Facility | | $3,311.31 | $26,302.68 | $75,857.76 |