- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,890.45 / $10,000.00 / $17,782.79
| Facility | | $3,890.45 | $10,000.00 | $17,782.79 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,890.45 / $5,370.32 / $13,182.57
| Facility | | $3,890.45 | $5,370.32 | $13,182.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,884.03 / $4,365.16 / $7,079.46
| Professional | | $2,884.03 | $4,365.16 | $7,079.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $602.56 / $1,905.46 / $6,309.57
| Facility | | $602.56 | $1,905.46 | $6,309.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,318.26 / $1,778.28 / $2,818.38
| Professional | | $1,318.26 | $1,778.28 | $2,818.38 |