- 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
- $588.84 / $660.69 / $1,258.93
| Professional | | $588.84 | $660.69 | $1,258.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,413.10 / $7,413.10 / $7,413.10
| Facility | | $7,413.10 | $7,413.10 | $7,413.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $660.69 / $851.14 / $1,047.13
| Professional | | $660.69 | $851.14 | $1,047.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $676.08 / $1,412.54 / $7,943.28
| Facility | | $676.08 | $1,412.54 | $7,943.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $537.03 / $741.31 / $4,897.79
| Professional | | $537.03 | $741.31 | $4,897.79 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,230.27 / $4,570.88 / $8,511.38
| Facility | | $1,230.27 | $4,570.88 | $8,511.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $524.81 / $645.65 / $870.96
| Professional | | $524.81 | $645.65 | $870.96 |