- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,706.14 / $3,955.04 / $15,000.00
| Facility | | $3,706.14 | $3,955.04 | $15,000.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $725.96 / $1,313.13 / $1,317.42
| Professional | | $725.96 | $1,313.13 | $1,317.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,170.71 / $1,377.31 / $2,030.57
| Professional | | $1,170.71 | $1,377.31 | $2,030.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,089.50 / $1,602.18 / $2,440.08
| Professional | | $1,089.50 | $1,602.18 | $2,440.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,649.00 / $4,915.00 / $7,205.00
| Facility | | $1,649.00 | $4,915.00 | $7,205.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,137.91 / $1,556.00 / $2,386.75
| Professional | | $1,137.91 | $1,556.00 | $2,386.75 |