- 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
- $812.83 / $954.99 / $1,513.56
| Professional | | $812.83 | $954.99 | $1,513.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $831.76 / $1,047.13 / $1,148.15
| Professional | | $831.76 | $1,047.13 | $1,148.15 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $851.14 / $1,047.13 / $1,202.26
| Professional | | $851.14 | $1,047.13 | $1,202.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $933.25 / $3,090.30 / $8,128.31
| Facility | | $933.25 | $3,090.30 | $8,128.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $741.31 / $954.99 / $6,760.83
| Professional | | $741.31 | $954.99 | $6,760.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,230.27 / $4,265.80 / $8,128.31
| Facility | | $1,230.27 | $4,265.80 | $8,128.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $707.95 / $870.96 / $1,380.38
| Professional | | $707.95 | $870.96 | $1,380.38 |