- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,500.00 / $3,600.00 / $12,154.00
| Facility | | $1,500.00 | $3,600.00 | $12,154.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $467.17 / $513.37 / $697.32
| Professional | | $467.17 | $513.37 | $697.32 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $624.00 / $624.00 / $624.00
| Facility | | $624.00 | $624.00 | $624.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $513.37 / $852.00 / $4,857.00
| Facility | | $513.37 | $852.00 | $4,857.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $635.59 / $806.70 / $4,051.68
| Professional | | $635.59 | $806.70 | $4,051.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $783.00 / $1,743.00 / $8,198.00
| Facility | | $783.00 | $1,743.00 | $8,198.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $629.41 / $763.93 / $988.90
| Professional | | $629.41 | $763.93 | $988.90 |