- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,023.29 / $3,467.37 / $10,000.00
| Facility | | $1,023.29 | $3,467.37 | $10,000.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $457.09 / $602.56 / $676.08
| Professional | | $457.09 | $602.56 | $676.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,623.41 / $8,912.51 / $20,892.96
| Facility | | $5,623.41 | $8,912.51 | $20,892.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,202.26 / $10,232.93 / $26,302.68
| Facility | | $1,202.26 | $10,232.93 | $26,302.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $549.54 / $776.25 / $1,288.25
| Professional | | $549.54 | $776.25 | $1,288.25 |