- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,000.00 / $1,378.28 / $1,411.31
| Facility | | $1,000.00 | $1,378.28 | $1,411.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,000.00 / $1,000.00 / $1,300.00
| Professional | | $1,000.00 | $1,000.00 | $1,300.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $503.51 / $1,558.61 / $1,852.11
| Professional | | $503.51 | $1,558.61 | $1,852.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $447.78 / $736.11 / $1,700.00
| Professional | | $447.78 | $736.11 | $1,700.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $442.46 / $600.79 / $1,048.18
| Professional | | $442.46 | $600.79 | $1,048.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $534.86 / $1,475.41 / $2,690.73
| Professional | | $534.86 | $1,475.41 | $2,690.73 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,068.50 / $1,068.50 / $2,250.73
| Professional | | $1,068.50 | $1,068.50 | $2,250.73 |