- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,000.00 / $7,838.38 / $14,860.56
| Facility | | $1,000.00 | $7,838.38 | $14,860.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $266.81 / $281.20 / $526.51
| Professional | | $266.81 | $281.20 | $526.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $303.12 / $425.16 / $532.42
| Professional | | $303.12 | $425.16 | $532.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.34 / $32.34 / $451.00
| Professional | | $32.34 | $32.34 | $451.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $314.38 / $410.05 / $532.42
| Professional | | $314.38 | $410.05 | $532.42 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,085.00 / $4,262.00 / $17,636.00
| Facility | | $3,085.00 | $4,262.00 | $17,636.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $355.96 / $444.94 / $639.12
| Professional | | $355.96 | $444.94 | $639.12 |