- 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
- $457.09 / $524.81 / $870.96
| Professional | | $457.09 | $524.81 | $870.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $346.74 / $602.56 / $851.14
| Professional | | $346.74 | $602.56 | $851.14 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $489.78 / $741.31 / $8,128.31
| Facility | | $489.78 | $741.31 | $8,128.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $436.52 / $588.84 / $4,786.30
| Professional | | $436.52 | $588.84 | $4,786.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,621.81 / $5,754.40 / $10,715.19
| Facility | | $1,621.81 | $5,754.40 | $10,715.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $407.38 / $537.03 / $776.25
| Professional | | $407.38 | $537.03 | $776.25 |