- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,025.60 / $7,585.78 / $13,489.63
| Facility | | $6,025.60 | $7,585.78 | $13,489.63 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,120.11 / $11,748.98 / $22,908.68
| Facility | | $9,120.11 | $11,748.98 | $22,908.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,570.88 / $4,570.88 / $4,570.88
| Facility | | $4,570.88 | $4,570.88 | $4,570.88 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $794.33 / $1,412.54 / $8,912.51
| Facility | | $794.33 | $1,412.54 | $8,912.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,659.59 / $1,995.26 / $2,691.53
| Professional | | $1,659.59 | $1,995.26 | $2,691.53 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,570.88 / $4,570.88 / $4,570.88
| Facility | | $4,570.88 | $4,570.88 | $4,570.88 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,309.57 / $7,413.10 / $9,120.11
| Facility | | $6,309.57 | $7,413.10 | $9,120.11 |