- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,165.95 / $8,511.38 / $14,454.40
| Facility | | $6,165.95 | $8,511.38 | $14,454.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,772.37 / $12,589.25 / $24,547.09
| Facility | | $9,772.37 | $12,589.25 | $24,547.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $870.96 / $1,905.46 / $10,715.19
| Facility | | $870.96 | $1,905.46 | $10,715.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,949.84 / $1,995.26 / $2,754.23
| Professional | | $1,949.84 | $1,995.26 | $2,754.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,918.31 / $8,128.31 / $10,000.00
| Facility | | $6,918.31 | $8,128.31 | $10,000.00 |