- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,019.95 / $7,943.28 / $23,988.33
| Facility | | $3,019.95 | $7,943.28 | $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
- $2,187.76 / $2,884.03 / $3,630.78
| Professional | | $2,187.76 | $2,884.03 | $3,630.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,513.56 / $2,344.23 / $3,801.89
| Facility | | $1,513.56 | $2,344.23 | $3,801.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,511.89 / $2,951.21 / $3,090.30
| Facility | | $2,511.89 | $2,951.21 | $3,090.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,513.56 / $2,344.23 / $3,388.44
| Facility | | $1,513.56 | $2,344.23 | $3,388.44 |
- 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
- $3,311.31 / $26,302.68 / $56,234.13
| Facility | | $3,311.31 | $26,302.68 | $56,234.13 |