- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,039.50 / $2,173.00 / $4,730.00
| Facility | | $1,039.50 | $2,173.00 | $4,730.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,072.00 / $3,931.00 / $5,258.00
| Facility | | $3,072.00 | $3,931.00 | $5,258.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,277.64 / $1,277.64 / $1,277.64
| Facility | | $1,277.64 | $1,277.64 | $1,277.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $17.28 / $1,098.21 / $1,459.63
| Professional | | $17.28 | $1,098.21 | $1,459.63 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,520.62 / $2,520.62 / $2,520.62
| Facility | | $2,520.62 | $2,520.62 | $2,520.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,642.00 / $3,000.00 / $9,042.00
| Facility | | $1,642.00 | $3,000.00 | $9,042.00 |