- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,584.89 / $7,762.47 / $11,220.18
| Facility | | $1,584.89 | $7,762.47 | $11,220.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,412.54 / $6,165.95 / $8,912.51
| Professional | | $1,412.54 | $6,165.95 | $8,912.51 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,365.16 / $5,011.87 / $7,244.36
| Facility | | $4,365.16 | $5,011.87 | $7,244.36 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,047.13 / $6,606.93 / $11,220.18
| Facility | | $1,047.13 | $6,606.93 | $11,220.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,412.54 / $6,760.83 / $10,964.78
| Professional | | $1,412.54 | $6,760.83 | $10,964.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.00 / $10.00 / $10.00
| Professional | | $10.00 | $10.00 | $10.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $660.69 / $2,570.40 / $6,760.83
| Facility | | $660.69 | $2,570.40 | $6,760.83 |