- 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
- $177.83 / $213.80 / $371.54
| Professional | | $177.83 | $213.80 | $371.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $199.53 / $275.42 / $354.81
| Professional | | $199.53 | $275.42 | $354.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $218.78 / $2,691.53 / $7,943.28
| Facility | | $218.78 | $2,691.53 | $7,943.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $177.83 / $251.19 / $1,412.54
| Professional | | $177.83 | $251.19 | $1,412.54 |
- 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
- $169.82 / $223.87 / $338.84
| Professional | | $169.82 | $223.87 | $338.84 |