- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,445.44 / $1,905.46 / $23,988.33
| Facility | | $1,445.44 | $1,905.46 | $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
- $1,148.15 / $1,513.56 / $1,778.28
| Professional | | $1,148.15 | $1,513.56 | $1,778.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $724.44 / $1,122.02 / $1,778.28
| Facility | | $724.44 | $1,122.02 | $1,778.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,174.90 / $1,412.54 / $1,513.56
| Facility | | $1,174.90 | $1,412.54 | $1,513.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $741.31 / $1,122.02 / $1,584.89
| Facility | | $741.31 | $1,122.02 | $1,584.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13,489.63 / $33,113.11 / $52,480.75
| Facility | | $13,489.63 | $33,113.11 | $52,480.75 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,019.95 / $20,892.96 / $31,622.78
| Facility | | $3,019.95 | $20,892.96 | $31,622.78 |