- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $41,686.94 / $43,651.58 / $70,794.58
| Facility | | $41,686.94 | $43,651.58 | $70,794.58 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,548.82 / $1,862.09 / $2,344.23
| Facility | | $1,548.82 | $1,862.09 | $2,344.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,698.24 / $1,778.28 / $2,137.96
| Professional | | $1,698.24 | $1,778.28 | $2,137.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,089.30 / $2,089.30 / $2,089.30
| Facility | | $2,089.30 | $2,089.30 | $2,089.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,584.89 / $1,862.09 / $2,089.30
| Professional | | $1,584.89 | $1,862.09 | $2,089.30 |