- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $389.05 / $1,000.00 / $7,079.46
| Facility | | $389.05 | $1,000.00 | $7,079.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,137.96 / $2,570.40 / $2,951.21
| Facility | | $2,137.96 | $2,570.40 | $2,951.21 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $416.87 / $416.87 / $416.87
| Facility | | $416.87 | $416.87 | $416.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $575.44 / $741.31 / $870.96
| Professional | | $575.44 | $741.31 | $870.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $562.34 / $891.25 / $1,348.96
| Professional | | $562.34 | $891.25 | $1,348.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $354.81 / $602.56 / $1,023.29
| Facility | | $354.81 | $602.56 | $1,023.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $316.23 / $457.09 / $2,691.53
| Facility | | $316.23 | $457.09 | $2,691.53 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,071.52 / $2,137.96 / $3,981.07
| Facility | | $1,071.52 | $2,137.96 | $3,981.07 |