- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,424.15 / $3,706.14 / $15,000.00
| Facility | | $2,424.15 | $3,706.14 | $15,000.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $315.37 / $546.79 / $582.63
| Professional | | $315.37 | $546.79 | $582.63 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,448.83 / $6,475.90 / $8,533.79
| Facility | | $4,448.83 | $6,475.90 | $8,533.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $858.18 / $1,009.62 / $1,009.62
| Professional | | $858.18 | $1,009.62 | $1,009.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,146.00 / $4,086.00 / $9,622.00
| Facility | | $3,146.00 | $4,086.00 | $9,622.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $561.15 / $756.23 / $1,171.43
| Professional | | $561.15 | $756.23 | $1,171.43 |