- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,606.93 / $7,079.46 / $10,232.93
| Facility | | $6,606.93 | $7,079.46 | $10,232.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,630.27 / $3,467.37 / $4,168.69
| Professional | | $2,630.27 | $3,467.37 | $4,168.69 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,120.11 / $16,218.10 / $41,686.94
| Facility | | $9,120.11 | $16,218.10 | $41,686.94 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,981.07 / $8,709.64 / $15,135.61
| Facility | | $3,981.07 | $8,709.64 | $15,135.61 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,311.31 / $8,709.64 / $15,135.61
| Facility | | $3,311.31 | $8,709.64 | $15,135.61 |