- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,495.41 / $10,000.00 / $13,489.63
| Facility | | $5,495.41 | $10,000.00 | $13,489.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $588.84 / $4,168.69 / $5,128.61
| Professional | | $588.84 | $4,168.69 | $5,128.61 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,079.46 / $7,413.10 / $7,413.10
| Facility | | $7,079.46 | $7,413.10 | $7,413.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,548.13 / $3,548.13 / $3,715.35
| Facility | | $3,548.13 | $3,548.13 | $3,715.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $39.81 / $39.81 / $39.81
| Professional | | $39.81 | $39.81 | $39.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,897.79 / $4,897.79 / $6,606.93
| Facility | | $4,897.79 | $4,897.79 | $6,606.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,290.87 / $3,311.31 / $12,302.69
| Professional | | $2,290.87 | $3,311.31 | $12,302.69 |