- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,998.68 / $5,496.89 / $7,920.26
| Facility | | $4,998.68 | $5,496.89 | $7,920.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,664.70 / $1,664.70 / $1,664.70
| Facility | | $1,664.70 | $1,664.70 | $1,664.70 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,979.49 / $5,225.43 / $6,370.94
| Professional | | $3,979.49 | $5,225.43 | $6,370.94 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,340.41 / $3,744.79 / $7,110.46
| Facility | | $2,340.41 | $3,744.79 | $7,110.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,913.44 / $4,847.72 / $5,128.18
| Facility | | $2,913.44 | $4,847.72 | $5,128.18 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,340.41 / $4,048.91 / $7,110.46
| Facility | | $2,340.41 | $4,048.91 | $7,110.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13,294.81 / $13,294.81 / $13,294.81
| Facility | | $13,294.81 | $13,294.81 | $13,294.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,345.00 / $7,664.00 / $31,303.00
| Facility | | $1,345.00 | $7,664.00 | $31,303.00 |