- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,570.88 / $7,413.10 / $7,943.28
| Facility | | $4,570.88 | $7,413.10 | $7,943.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,659.59 / $1,659.59 / $1,659.59
| Facility | | $1,659.59 | $1,659.59 | $1,659.59 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,981.07 / $5,495.41 / $7,079.46
| Professional | | $3,981.07 | $5,495.41 | $7,079.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,818.38 / $4,073.80 / $7,079.46
| Facility | | $2,818.38 | $4,073.80 | $7,079.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,365.16 / $5,754.40 / $5,888.44
| Facility | | $4,365.16 | $5,754.40 | $5,888.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,570.40 / $4,073.80 / $6,918.31
| Facility | | $2,570.40 | $4,073.80 | $6,918.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $15,848.93 / $15,848.93 / $15,848.93
| Facility | | $15,848.93 | $15,848.93 | $15,848.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,412.54 / $7,585.78 / $31,622.78
| Facility | | $1,412.54 | $7,585.78 | $31,622.78 |