- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,606.93 / $7,079.46 / $10,715.19
| Facility | | $6,606.93 | $7,079.46 | $10,715.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $11,220.18 / $11,220.18 / $11,220.18
| Professional | | $11,220.18 | $11,220.18 | $11,220.18 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,762.47 / $13,803.84 / $35,481.34
| Facility | | $7,762.47 | $13,803.84 | $35,481.34 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $64.57 / $64.57 / $64.57
| Facility | | $64.57 | $64.57 | $64.57 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,311.31 / $7,762.47 / $12,882.50
| Facility | | $3,311.31 | $7,762.47 | $12,882.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,584.89 / $5,370.32 / $12,589.25
| Facility | | $1,584.89 | $5,370.32 | $12,589.25 |