- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,000.00 / $2,754.23 / $7,413.10
| Facility | | $1,000.00 | $2,754.23 | $7,413.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $107.15 / $165.96 / $257.04
| Professional | | $107.15 | $165.96 | $257.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $144.54 / $181.97 / $257.04
| Professional | | $144.54 | $181.97 | $257.04 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $154.88 / $891.25 / $9,772.37
| Facility | | $154.88 | $891.25 | $9,772.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $162.18 / $239.88 / $1,230.27
| Professional | | $162.18 | $239.88 | $1,230.27 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,202.26 / $2,818.38 / $10,471.29
| Facility | | $1,202.26 | $2,818.38 | $10,471.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $154.88 / $218.78 / $371.54
| Professional | | $154.88 | $218.78 | $371.54 |