- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,000.00 / $2,145.78 / $7,838.38
| Facility | | $1,000.00 | $2,145.78 | $7,838.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $224.96 / $1,099.26 / $2,228.67
| Professional | | $224.96 | $1,099.26 | $2,228.67 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $50.00 / $85.00 / $1,010.75
| Professional | | $50.00 | $85.00 | $1,010.75 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $224.97 / $706.78 / $2,228.67
| Facility | | $224.97 | $706.78 | $2,228.67 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,085.00 / $5,089.00 / $17,636.00
| Facility | | $3,085.00 | $5,089.00 | $17,636.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,319.38 / $1,759.16 / $2,672.58
| Professional | | $1,319.38 | $1,759.16 | $2,672.58 |