- 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
- $186.21 / $218.78 / $512.86
| Professional | | $186.21 | $218.78 | $512.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $40.74 / $40.74 / $40.74
| Professional | | $40.74 | $40.74 | $40.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $162.18 / $234.42 / $263.03
| Professional | | $162.18 | $234.42 | $263.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $199.53 / $1,096.48 / $5,888.44
| Facility | | $199.53 | $1,096.48 | $5,888.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $138.04 / $204.17 / $5,248.07
| Professional | | $138.04 | $204.17 | $5,248.07 |
- 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
- $128.82 / $177.83 / $245.47
| Professional | | $128.82 | $177.83 | $245.47 |