- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,089.30 / $4,897.79 / $13,182.57
| Facility | | $2,089.30 | $4,897.79 | $13,182.57 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $67,608.30 / $74,131.02 / $75,857.76
| Facility | | $67,608.30 | $74,131.02 | $75,857.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $645.65 / $645.65 / $645.65
| Facility | | $645.65 | $645.65 | $645.65 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,621.81 / $2,041.74 / $2,454.71
| Professional | | $1,621.81 | $2,041.74 | $2,454.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,265.80 / $4,265.80 / $4,265.80
| Professional | | $4,265.80 | $4,265.80 | $4,265.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,737.80 / $2,344.23 / $3,548.13
| Facility | | $1,737.80 | $2,344.23 | $3,548.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,698.24 / $2,398.83 / $10,964.78
| Facility | | $1,698.24 | $2,398.83 | $10,964.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13,182.57 / $24,547.09 / $64,565.42
| Facility | | $13,182.57 | $24,547.09 | $64,565.42 |