- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,000.00 / $2,630.27 / $6,760.83
| Facility | | $1,000.00 | $2,630.27 | $6,760.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $741.31 / $1,000.00 / $1,380.38
| Professional | | $741.31 | $1,000.00 | $1,380.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $831.76 / $2,691.53 / $3,981.07
| Facility | | $831.76 | $2,691.53 | $3,981.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,230.27 / $1,288.25 / $2,454.71
| Professional | | $1,230.27 | $1,288.25 | $2,454.71 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $660.69 / $1,122.02 / $3,630.78
| Facility | | $660.69 | $1,122.02 | $3,630.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $870.96 / $1,318.26 / $2,290.87
| Facility | | $870.96 | $1,318.26 | $2,290.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $467.74 / $467.74 / $6,456.54
| Professional | | $467.74 | $467.74 | $6,456.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,000.00 / $1,318.26 / $1,548.82
| Facility | | $1,000.00 | $1,318.26 | $1,548.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $467.74 / $467.74 / $676.08
| Professional | | $467.74 | $467.74 | $676.08 |