- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,000.00 / $1,412.54 / $3,388.44
| Facility | | $1,000.00 | $1,412.54 | $3,388.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $575.44 / $724.44 / $1,122.02
| Professional | | $575.44 | $724.44 | $1,122.02 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,096.48 / $1,348.96 / $2,630.27
| Facility | | $1,096.48 | $1,348.96 | $2,630.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $562.34 / $562.34 / $891.25
| Professional | | $562.34 | $562.34 | $891.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $724.44 / $954.99 / $1,071.52
| Facility | | $724.44 | $954.99 | $1,071.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $912.01 / $5,248.07 / $5,248.07
| Professional | | $912.01 | $5,248.07 | $5,248.07 |