- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $467.74 / $1,288.25 / $4,677.35
| Facility | | $467.74 | $1,288.25 | $4,677.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,000.00 / $1,288.25 / $1,778.28
| Professional | | $1,000.00 | $1,288.25 | $1,778.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,000.00 / $1,202.26 / $1,258.93
| Professional | | $1,000.00 | $1,202.26 | $1,258.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,096.48 / $1,096.48 / $1,096.48
| Professional | | $1,096.48 | $1,096.48 | $1,096.48 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,000.00 / $1,445.44 / $2,754.23
| Facility | | $1,000.00 | $1,445.44 | $2,754.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $398.11 / $512.86 / $1,071.52
| Facility | | $398.11 | $512.86 | $1,071.52 |