- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,000.00 / $3,630.78 / $9,549.93
| Facility | | $1,000.00 | $3,630.78 | $9,549.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,412.54 / $2,137.96 / $5,888.44
| Facility | | $1,412.54 | $2,137.96 | $5,888.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $707.95 / $831.76 / $1,047.13
| Professional | | $707.95 | $831.76 | $1,047.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,230.27 / $1,548.82 / $1,862.09
| Professional | | $1,230.27 | $1,548.82 | $1,862.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $794.33 / $1,230.27 / $1,819.70
| Facility | | $794.33 | $1,230.27 | $1,819.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $758.58 / $1,122.02 / $7,413.10
| Facility | | $758.58 | $1,122.02 | $7,413.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,698.24 / $3,467.37 / $7,079.46
| Facility | | $1,698.24 | $3,467.37 | $7,079.46 |