- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,715.35 / $4,786.30 / $15,848.93
| Facility | | $3,715.35 | $4,786.30 | $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
- $2,691.53 / $3,548.13 / $4,466.84
| Professional | | $2,691.53 | $3,548.13 | $4,466.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,862.09 / $2,884.03 / $4,677.35
| Facility | | $1,862.09 | $2,884.03 | $4,677.35 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,019.95 / $3,630.78 / $3,801.89
| Facility | | $3,019.95 | $3,630.78 | $3,801.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,862.09 / $2,884.03 / $4,168.69
| Facility | | $1,862.09 | $2,884.03 | $4,168.69 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,918.31 / $16,595.87 / $26,915.35
| Facility | | $6,918.31 | $16,595.87 | $26,915.35 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,884.03 / $17,782.79 / $31,622.78
| Facility | | $2,884.03 | $17,782.79 | $31,622.78 |