- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,181.00 / $1,821.00 / $9,477.00
| Facility | | $1,181.00 | $1,821.00 | $9,477.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,241.72 / $1,241.72 / $2,295.03
| Professional | | $1,241.72 | $1,241.72 | $2,295.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,000.00 / $2,500.00 / $9,073.00
| Facility | | $2,000.00 | $2,500.00 | $9,073.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $375.00 / $1,056.00 / $2,558.00
| Facility | | $375.00 | $1,056.00 | $2,558.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,640.05 / $2,449.05 / $3,523.70
| Professional | | $1,640.05 | $2,449.05 | $3,523.70 |