- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,388.44 / $7,244.36 / $44,668.36
| Facility | | $3,388.44 | $7,244.36 | $44,668.36 |
- 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
- $2,398.83 / $3,311.31 / $3,981.07
| Professional | | $2,398.83 | $3,311.31 | $3,981.07 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,698.24 / $2,511.89 / $4,265.80
| Facility | | $1,698.24 | $2,511.89 | $4,265.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,754.23 / $3,311.31 / $3,467.37
| Facility | | $2,754.23 | $3,311.31 | $3,467.37 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,621.81 / $2,511.89 / $4,073.80
| Facility | | $1,621.81 | $2,511.89 | $4,073.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,413.10 / $13,489.63 / $35,481.34
| Facility | | $7,413.10 | $13,489.63 | $35,481.34 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,818.38 / $7,943.28 / $25,118.86
| Facility | | $2,818.38 | $7,943.28 | $25,118.86 |