- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,630.78 / $15,135.61 / $33,884.42
| Facility | | $3,630.78 | $15,135.61 | $33,884.42 |
- 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
- $2,691.53 / $3,548.13 / $4,265.80
| Professional | | $2,691.53 | $3,548.13 | $4,265.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,737.80 / $3,019.95 / $20,892.96
| Facility | | $1,737.80 | $3,019.95 | $20,892.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,019.95 / $3,467.37 / $3,630.78
| Facility | | $3,019.95 | $3,467.37 | $3,630.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,698.24 / $2,754.23 / $4,365.16
| Facility | | $1,698.24 | $2,754.23 | $4,365.16 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $27,542.29 / $58,884.37 / $89,125.09
| Facility | | $27,542.29 | $58,884.37 | $89,125.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,981.07 / $35,481.34 / $117,489.76
| Facility | | $3,981.07 | $35,481.34 | $117,489.76 |