- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,162.28 / $6,606.93 / $8,128.31
| Facility | | $3,162.28 | $6,606.93 | $8,128.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,244.36 / $7,244.36 / $7,244.36
| Facility | | $7,244.36 | $7,244.36 | $7,244.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,698.24 / $2,951.21 / $6,760.83
| Professional | | $1,698.24 | $2,951.21 | $6,760.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,778.28 / $4,073.80 / $13,182.57
| Facility | | $1,778.28 | $4,073.80 | $13,182.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,951.21 / $4,365.16 / $4,897.79
| Professional | | $2,951.21 | $4,365.16 | $4,897.79 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,244.36 / $7,244.36 / $7,244.36
| Facility | | $7,244.36 | $7,244.36 | $7,244.36 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,168.69 / $9,120.11 / $15,488.17
| Facility | | $4,168.69 | $9,120.11 | $15,488.17 |