- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,000.00 / $3,467.37 / $6,760.83
| Facility | | $1,000.00 | $3,467.37 | $6,760.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $186.21 / $257.04 / $794.33
| Professional | | $186.21 | $257.04 | $794.33 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $186.21 / $3,548.13 / $8,511.38
| Facility | | $186.21 | $3,548.13 | $8,511.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $199.53 / $288.40 / $4,677.35
| Professional | | $199.53 | $288.40 | $4,677.35 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,230.27 / $4,265.80 / $8,317.64
| Facility | | $1,230.27 | $4,265.80 | $8,317.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $194.98 / $263.03 / $389.05
| Professional | | $194.98 | $263.03 | $389.05 |