- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,202.26 / $3,235.94 / $11,481.54
| Facility | | $1,202.26 | $3,235.94 | $11,481.54 |
- 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
- $1,479.11 / $1,479.11 / $1,995.26
| Professional | | $1,479.11 | $1,479.11 | $1,995.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $851.14 / $1,148.15 / $1,778.28
| Facility | | $851.14 | $1,148.15 | $1,778.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,011.87 / $11,748.98 / $18,620.87
| Facility | | $5,011.87 | $11,748.98 | $18,620.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $42,657.95 / $50,118.72 / $50,118.72
| Facility | | $42,657.95 | $50,118.72 | $50,118.72 |