- 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
- $294.39 / $1,023.86 / $1,058.75
| Professional | | $294.39 | $1,023.86 | $1,058.75 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $50.00 / $85.00 / $1,131.11
| Professional | | $50.00 | $85.00 | $1,131.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $294.39 / $583.73 / $918.08
| Facility | | $294.39 | $583.73 | $918.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $230.00 / $1,158.00 / $1,401.00
| Facility | | $230.00 | $1,158.00 | $1,401.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $518.26 / $676.49 / $996.29
| Professional | | $518.26 | $676.49 | $996.29 |