- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,548.82 / $3,801.89 / $12,589.25
| Facility | | $1,548.82 | $3,801.89 | $12,589.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,890.45 / $5,128.61 / $10,000.00
| Facility | | $3,890.45 | $5,128.61 | $10,000.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $251.19 / $1,621.81 / $4,265.80
| Facility | | $251.19 | $1,621.81 | $4,265.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $512.86 / $2,137.96 / $3,090.30
| Professional | | $512.86 | $2,137.96 | $3,090.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,570.40 / $4,365.16 / $8,128.31
| Facility | | $2,570.40 | $4,365.16 | $8,128.31 |