- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,268.78 / $5,083.34 / $9,573.33
| Facility | | $3,268.78 | $5,083.34 | $9,573.33 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,738.20 / $20,977.18 / $29,216.95
| Facility | | $12,738.20 | $20,977.18 | $29,216.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,743.32 / $3,291.98 / $4,064.23
| Professional | | $2,743.32 | $3,291.98 | $4,064.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,065.49 / $3,863.11 / $5,524.24
| Facility | | $3,065.49 | $3,863.11 | $5,524.24 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,662.61 / $3,656.85 / $6,813.34
| Facility | | $2,662.61 | $3,656.85 | $6,813.34 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,547.00 / $3,130.00 / $5,226.00
| Facility | | $1,547.00 | $3,130.00 | $5,226.00 |