- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,548.82 / $10,471.29 / $18,197.01
| Facility | | $1,548.82 | $10,471.29 | $18,197.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $9,772.37 / $9,772.37 / $9,772.37
| Professional | | $9,772.37 | $9,772.37 | $9,772.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,238.72 / $2,238.72 / $2,238.72
| Professional | | $2,238.72 | $2,238.72 | $2,238.72 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,073.80 / $6,606.93 / $12,302.69
| Facility | | $4,073.80 | $6,606.93 | $12,302.69 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,025.60 / $6,025.60 / $7,762.47
| Facility | | $6,025.60 | $6,025.60 | $7,762.47 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,772.37 / $14,454.40 / $16,595.87
| Facility | | $9,772.37 | $14,454.40 | $16,595.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $30.20 / $30.20 / $30.20
| Professional | | $30.20 | $30.20 | $30.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,754.23 / $11,220.18 / $17,378.01
| Facility | | $2,754.23 | $11,220.18 | $17,378.01 |