- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,548.13 / $20,892.96 / $43,651.58
| Facility | | $3,548.13 | $20,892.96 | $43,651.58 |
- 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
- $2,398.83 / $3,162.28 / $3,801.89
| Professional | | $2,398.83 | $3,162.28 | $3,801.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,584.89 / $2,818.38 / $23,988.33
| Facility | | $1,584.89 | $2,818.38 | $23,988.33 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,691.53 / $3,090.30 / $3,311.31
| Facility | | $2,691.53 | $3,090.30 | $3,311.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,584.89 / $2,570.40 / $3,890.45
| Facility | | $1,584.89 | $2,570.40 | $3,890.45 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $44,668.36 / $63,095.73 / $89,125.09
| Facility | | $44,668.36 | $63,095.73 | $89,125.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,019.95 / $20,892.96 / $75,857.76
| Facility | | $3,019.95 | $20,892.96 | $75,857.76 |