- 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
- $190.47 / $198.15 / $315.83
| Professional | | $190.47 | $198.15 | $315.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $60.00 / $85.00 / $374.22
| Professional | | $60.00 | $85.00 | $374.22 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $315.83 / $315.83 / $315.83
| Facility | | $315.83 | $315.83 | $315.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,315.00 / $11,259.00 / $12,494.00
| Facility | | $7,315.00 | $11,259.00 | $12,494.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $266.97 / $322.85 / $463.74
| Professional | | $266.97 | $322.85 | $463.74 |