- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,467.37 / $7,943.28 / $15,848.93
| Facility | | $3,467.37 | $7,943.28 | $15,848.93 |
- 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
- $2,454.71 / $3,311.31 / $4,073.80
| Professional | | $2,454.71 | $3,311.31 | $4,073.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,621.81 / $2,630.27 / $6,025.60
| Facility | | $1,621.81 | $2,630.27 | $6,025.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,884.03 / $3,388.44 / $3,467.37
| Facility | | $2,884.03 | $3,388.44 | $3,467.37 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,659.59 / $2,511.89 / $3,890.45
| Facility | | $1,659.59 | $2,511.89 | $3,890.45 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13,489.63 / $19,952.62 / $51,286.14
| Facility | | $13,489.63 | $19,952.62 | $51,286.14 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,019.95 / $20,892.96 / $56,234.13
| Facility | | $3,019.95 | $20,892.96 | $56,234.13 |