- 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
- $162.18 / $190.55 / $245.47
| Professional | | $162.18 | $190.55 | $245.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $125.89 / $173.78 / $1,949.84
| Professional | | $125.89 | $173.78 | $1,949.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $162.18 / $1,318.26 / $3,981.07
| Facility | | $162.18 | $1,318.26 | $3,981.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $162.18 / $218.78 / $1,412.54
| Professional | | $162.18 | $218.78 | $1,412.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $575.44 / $1,995.26 / $3,801.89
| Facility | | $575.44 | $1,995.26 | $3,801.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $158.49 / $213.80 / $302.00
| Professional | | $158.49 | $213.80 | $302.00 |