- 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
- $295.12 / $346.74 / $446.68
| Professional | | $295.12 | $346.74 | $446.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $295.12 / $3,019.95 / $7,585.78
| Facility | | $295.12 | $3,019.95 | $7,585.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $302.00 / $407.38 / $2,754.23
| Professional | | $302.00 | $407.38 | $2,754.23 |
- 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
- $295.12 / $407.38 / $588.84
| Professional | | $295.12 | $407.38 | $588.84 |