- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,570.88 / $5,754.40 / $13,182.57
| Facility | | $4,570.88 | $5,754.40 | $13,182.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,995.26 / $4,073.80 / $4,786.30
| Professional | | $1,995.26 | $4,073.80 | $4,786.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,238.72 / $3,388.44 / $7,943.28
| Facility | | $2,238.72 | $3,388.44 | $7,943.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,467.37 / $4,466.84 / $4,570.88
| Facility | | $3,467.37 | $4,466.84 | $4,570.88 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,238.72 / $3,235.94 / $5,623.41
| Facility | | $2,238.72 | $3,235.94 | $5,623.41 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,022.64 / $12,022.64 / $12,022.64
| Facility | | $12,022.64 | $12,022.64 | $12,022.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,445.44 / $8,128.31 / $12,882.50
| Facility | | $1,445.44 | $8,128.31 | $12,882.50 |