- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,623.41 / $12,589.25 / $21,877.62
| Facility | | $5,623.41 | $12,589.25 | $21,877.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,019.95 / $4,168.69 / $10,000.00
| Facility | | $3,019.95 | $4,168.69 | $10,000.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,344.23 / $3,311.31 / $4,786.30
| Professional | | $2,344.23 | $3,311.31 | $4,786.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $891.25 / $2,187.76 / $6,606.93
| Facility | | $891.25 | $2,187.76 | $6,606.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,071.52 / $1,445.44 / $2,344.23
| Professional | | $1,071.52 | $1,445.44 | $2,344.23 |