- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,943.28 / $10,964.78 / $18,197.01
| Facility | | $7,943.28 | $10,964.78 | $18,197.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,071.52 / $1,479.11 / $1,698.24
| Professional | | $1,071.52 | $1,479.11 | $1,698.24 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,041.74 / $2,398.83 / $2,951.21
| Facility | | $2,041.74 | $2,398.83 | $2,951.21 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,332.54 / $9,332.54 / $12,022.64
| Facility | | $9,332.54 | $9,332.54 | $12,022.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,380.38 / $1,698.24 / $2,630.27
| Facility | | $1,380.38 | $1,698.24 | $2,630.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $30.20 / $30.20 / $30.20
| Professional | | $30.20 | $30.20 | $30.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,709.64 / $20,417.38 / $25,703.96
| Facility | | $8,709.64 | $20,417.38 | $25,703.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,412.54 / $1,905.46 / $3,162.28
| Professional | | $1,412.54 | $1,905.46 | $3,162.28 |