- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,248.07 / $7,943.28 / $9,772.37
| Facility | | $5,248.07 | $7,943.28 | $9,772.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,715.35 / $8,128.31 / $10,000.00
| Professional | | $3,715.35 | $8,128.31 | $10,000.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,128.61 / $7,585.78 / $11,220.18
| Facility | | $5,128.61 | $7,585.78 | $11,220.18 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,888.44 / $7,585.78 / $8,128.31
| Facility | | $5,888.44 | $7,585.78 | $8,128.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,265.80 / $5,754.40 / $9,772.37
| Facility | | $4,265.80 | $5,754.40 | $9,772.37 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $21,379.62 / $21,379.62 / $21,379.62
| Facility | | $21,379.62 | $21,379.62 | $21,379.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,454.71 / $10,232.93 / $37,153.52
| Facility | | $2,454.71 | $10,232.93 | $37,153.52 |