- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,241.22 / $10,431.19 / $20,928.72
| Facility | | $4,241.22 | $10,431.19 | $20,928.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $655.61 / $655.61 / $655.61
| Professional | | $655.61 | $655.61 | $655.61 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,551.47 / $4,671.14 / $9,035.51
| Facility | | $3,551.47 | $4,671.14 | $9,035.51 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $590.04 / $2,192.80 / $7,772.00
| Facility | | $590.04 | $2,192.80 | $7,772.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $986.07 / $1,183.28 / $1,544.84
| Facility | | $986.07 | $1,183.28 | $1,544.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,044.00 / $3,726.00 / $7,934.00
| Facility | | $3,044.00 | $3,726.00 | $7,934.00 |