- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,365.16 / $10,000.00 / $29,512.09
| Facility | | $4,365.16 | $10,000.00 | $29,512.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,238.72 / $4,570.88 / $5,623.41
| Facility | | $2,238.72 | $4,570.88 | $5,623.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,698.24 / $1,995.26 / $2,137.96
| Professional | | $1,698.24 | $1,995.26 | $2,137.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,479.11 / $1,862.09 / $2,089.30
| Facility | | $1,479.11 | $1,862.09 | $2,089.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,698.24 / $1,995.26 / $2,089.30
| Professional | | $1,698.24 | $1,995.26 | $2,089.30 |