- 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
- $363.08 / $407.38 / $489.78
| Professional | | $363.08 | $407.38 | $489.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $281.84 / $467.74 / $676.08
| Professional | | $281.84 | $467.74 | $676.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $389.05 / $1,819.70 / $6,025.60
| Facility | | $389.05 | $1,819.70 | $6,025.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $331.13 / $436.52 / $3,235.94
| Professional | | $331.13 | $436.52 | $3,235.94 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $891.25 / $3,388.44 / $6,456.54
| Facility | | $891.25 | $3,388.44 | $6,456.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $316.23 / $426.58 / $602.56
| Professional | | $316.23 | $426.58 | $602.56 |