- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,511.89 / $5,888.44 / $13,182.57
| Facility | | $2,511.89 | $5,888.44 | $13,182.57 |
- 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
- $2,089.30 / $2,691.53 / $3,162.28
| Professional | | $2,089.30 | $2,691.53 | $3,162.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,467.37 / $4,265.80 / $5,623.41
| Professional | | $3,467.37 | $4,265.80 | $5,623.41 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,290.87 / $3,235.94 / $4,897.79
| Facility | | $2,290.87 | $3,235.94 | $4,897.79 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,238.72 / $3,162.28 / $10,964.78
| Facility | | $2,238.72 | $3,162.28 | $10,964.78 |
- 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 |