- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,187.76 / $5,888.44 / $14,791.08
| Facility | | $2,187.76 | $5,888.44 | $14,791.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $107,151.93 / $117,489.76 / $117,489.76
| Facility | | $107,151.93 | $117,489.76 | $117,489.76 |
- 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
- $1,819.70 / $2,344.23 / $2,754.23
| Professional | | $1,819.70 | $2,344.23 | $2,754.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,951.21 / $3,715.35 / $4,897.79
| Professional | | $2,951.21 | $3,715.35 | $4,897.79 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,995.26 / $2,754.23 / $4,265.80
| Facility | | $1,995.26 | $2,754.23 | $4,265.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,949.84 / $2,754.23 / $10,232.93
| Facility | | $1,949.84 | $2,754.23 | $10,232.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,471.29 / $18,197.01 / $40,738.03
| Facility | | $10,471.29 | $18,197.01 | $40,738.03 |