- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,019.95 / $14,454.40 / $45,708.82
| Facility | | $3,019.95 | $14,454.40 | $45,708.82 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,659.59 / $1,659.59 / $1,659.59
| Facility | | $1,659.59 | $1,659.59 | $1,659.59 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,089.30 / $2,884.03 / $3,548.13
| Professional | | $2,089.30 | $2,884.03 | $3,548.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,513.56 / $2,089.30 / $4,897.79
| Facility | | $1,513.56 | $2,089.30 | $4,897.79 |
- 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
- $1,412.54 / $2,238.72 / $3,630.78
| Facility | | $1,412.54 | $2,238.72 | $3,630.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $23,442.29 / $32,359.37 / $38,904.51
| Facility | | $23,442.29 | $32,359.37 | $38,904.51 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,818.38 / $20,892.96 / $39,810.72
| Facility | | $2,818.38 | $20,892.96 | $39,810.72 |