- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,844.40 / $2,510.82 / $9,152.04
| Facility | | $1,844.40 | $2,510.82 | $9,152.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,044.00 / $2,070.60 / $2,262.00
| Professional | | $1,044.00 | $2,070.60 | $2,262.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,884.07 / $3,398.05 / $5,354.33
| Facility | | $1,884.07 | $3,398.05 | $5,354.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $547.09 / $597.91 / $663.68
| Professional | | $547.09 | $597.91 | $663.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,740.00 / $1,740.00 / $1,740.00
| Facility | | $1,740.00 | $1,740.00 | $1,740.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,131.00 / $1,401.31 / $13,211.41
| Facility | | $1,131.00 | $1,401.31 | $13,211.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $730.80 / $1,044.00 / $2,436.00
| Professional | | $730.80 | $1,044.00 | $2,436.00 |