- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,000.00 / $4,667.00 / $10,202.00
| Facility | | $1,000.00 | $4,667.00 | $10,202.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $334.37 / $988.59 / $1,000.00
| Professional | | $334.37 | $988.59 | $1,000.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $236.73 / $511.64 / $542.33
| Professional | | $236.73 | $511.64 | $542.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $336.74 / $468.35 / $1,006.14
| Professional | | $336.74 | $468.35 | $1,006.14 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,529.00 / $3,352.00 / $10,536.00
| Facility | | $1,529.00 | $3,352.00 | $10,536.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $297.74 / $478.43 / $956.03
| Professional | | $297.74 | $478.43 | $956.03 |