- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,116.62 / $7,920.26 / $52,078.26
| Facility | | $5,116.62 | $7,920.26 | $52,078.26 |
- 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
- $5,346.41 / $7,020.32 / $8,565.20
| Professional | | $5,346.41 | $7,020.32 | $8,565.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,540.97 / $6,026.87 / $9,306.91
| Facility | | $3,540.97 | $6,026.87 | $9,306.91 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,562.20 / $6,512.91 / $6,834.67
| Facility | | $4,562.20 | $6,512.91 | $6,834.67 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,704.80 / $6,897.70 / $9,306.91
| Facility | | $3,704.80 | $6,897.70 | $9,306.91 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $17,695.62 / $17,695.62 / $17,695.62
| Facility | | $17,695.62 | $17,695.62 | $17,695.62 |
- 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 |