- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,000.00 / $3,162.28 / $7,762.47
| Facility | | $1,000.00 | $3,162.28 | $7,762.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $870.96 / $1,000.00 / $2,754.23
| Professional | | $870.96 | $1,000.00 | $2,754.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $812.83 / $1,949.84 / $7,943.28
| Professional | | $812.83 | $1,949.84 | $7,943.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $912.01 / $1,148.15 / $2,511.89
| Professional | | $912.01 | $1,148.15 | $2,511.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $812.83 / $851.14 / $1,949.84
| Professional | | $812.83 | $851.14 | $1,949.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,344.23 / $16,218.10 / $26,915.35
| Facility | | $2,344.23 | $16,218.10 | $26,915.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $776.25 / $1,071.52 / $2,398.83
| Professional | | $776.25 | $1,071.52 | $2,398.83 |