- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,000.00 / $2,630.27 / $6,606.93
| Facility | | $1,000.00 | $2,630.27 | $6,606.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $575.44 / $741.31 / $1,071.52
| Professional | | $575.44 | $741.31 | $1,071.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $676.08 / $977.24 / $1,071.52
| Professional | | $676.08 | $977.24 | $1,071.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $346.74 / $1,288.25 / $5,888.44
| Facility | | $346.74 | $1,288.25 | $5,888.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $562.34 / $758.58 / $5,623.41
| Professional | | $562.34 | $758.58 | $5,623.41 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $346.74 / $1,949.84 / $6,165.95
| Facility | | $346.74 | $1,949.84 | $6,165.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $537.03 / $707.95 / $1,096.48
| Professional | | $537.03 | $707.95 | $1,096.48 |