- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,000.00 / $1,659.59 / $2,454.71
| Facility | | $1,000.00 | $1,659.59 | $2,454.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $758.58 / $794.33 / $1,000.00
| Professional | | $758.58 | $794.33 | $1,000.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,311.31 / $3,311.31 / $4,570.88
| Facility | | $3,311.31 | $3,311.31 | $4,570.88 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,398.83 / $2,398.83 / $2,398.83
| Facility | | $2,398.83 | $2,398.83 | $2,398.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $562.34 / $977.24 / $1,412.54
| Professional | | $562.34 | $977.24 | $1,412.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,230.27 / $2,951.21 / $7,244.36
| Facility | | $1,230.27 | $2,951.21 | $7,244.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $758.58 / $1,000.00 / $1,445.44
| Professional | | $758.58 | $1,000.00 | $1,445.44 |