- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,272.83 / $5,063.00 / $7,005.97
| Facility | | $3,272.83 | $5,063.00 | $7,005.97 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,325.76 / $8,967.21 / $21,657.35
| Facility | | $2,325.76 | $8,967.21 | $21,657.35 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,034.41 / $6,560.18 / $10,074.54
| Facility | | $6,034.41 | $6,560.18 | $10,074.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $550.00 / $550.00 / $550.00
| Facility | | $550.00 | $550.00 | $550.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,161.09 / $4,425.53 / $5,739.08
| Professional | | $3,161.09 | $4,425.53 | $5,739.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $607.00 / $3,629.00 / $10,000.00
| Facility | | $607.00 | $3,629.00 | $10,000.00 |