- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,466.84 / $13,182.57 / $28,183.83
| Facility | | $4,466.84 | $13,182.57 | $28,183.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10,964.78 / $10,964.78 / $10,964.78
| Professional | | $10,964.78 | $10,964.78 | $10,964.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $17,782.79 / $17,782.79 / $17,782.79
| Facility | | $17,782.79 | $17,782.79 | $17,782.79 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,232.93 / $48,977.88 / $83,176.38
| Facility | | $10,232.93 | $48,977.88 | $83,176.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,471.29 / $26,915.35 / $26,915.35
| Facility | | $10,471.29 | $26,915.35 | $26,915.35 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $23,442.29 / $30,902.95 / $60,255.96
| Facility | | $23,442.29 | $30,902.95 | $60,255.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,511.38 / $40,738.03 / $69,183.10
| Facility | | $8,511.38 | $40,738.03 | $69,183.10 |