- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,000.00 / $1,380.38 / $2,570.40
| Facility | | $1,000.00 | $1,380.38 | $2,570.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,000.00 / $1,380.38 / $2,454.71
| Professional | | $1,000.00 | $1,380.38 | $2,454.71 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,047.13 / $1,445.44 / $5,370.32
| Facility | | $1,047.13 | $1,445.44 | $5,370.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,380.38 / $1,445.44 / $3,162.28
| Professional | | $1,380.38 | $1,445.44 | $3,162.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,862.09 / $1,949.84 / $11,481.54
| Facility | | $1,862.09 | $1,949.84 | $11,481.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,445.44 / $1,445.44 / $4,365.16
| Professional | | $1,445.44 | $1,445.44 | $4,365.16 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,096.48 / $1,737.80 / $3,162.28
| Facility | | $1,096.48 | $1,737.80 | $3,162.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $954.99 / $1,380.38 / $2,041.74
| Professional | | $954.99 | $1,380.38 | $2,041.74 |