- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,121.08 / $7,920.26 / $57,403.89
| Facility | | $3,121.08 | $7,920.26 | $57,403.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,461.77 / $3,493.92 / $3,933.80
| Professional | | $2,461.77 | $3,493.92 | $3,933.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,303.21 / $3,558.06 / $4,951.92
| Facility | | $2,303.21 | $3,558.06 | $4,951.92 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,249.05 / $2,998.89 / $3,187.16
| Facility | | $2,249.05 | $2,998.89 | $3,187.16 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,303.21 / $3,784.80 / $4,951.92
| Facility | | $2,303.21 | $3,784.80 | $4,951.92 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,260.45 / $8,260.45 / $8,260.45
| Facility | | $8,260.45 | $8,260.45 | $8,260.45 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,364.00 / $7,664.00 / $36,803.00
| Facility | | $2,364.00 | $7,664.00 | $36,803.00 |