- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,370.32 / $14,125.38 / $28,840.32
| Facility | | $5,370.32 | $14,125.38 | $28,840.32 |
- 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
- $2,089.30 / $3,311.31 / $4,786.30
| Professional | | $2,089.30 | $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
- $1,122.02 / $1,584.89 / $2,570.40
| Professional | | $1,122.02 | $1,584.89 | $2,570.40 |