- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,000.00 / $5,370.32 / $7,079.46
| Facility | | $1,000.00 | $5,370.32 | $7,079.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $602.56 / $1,000.00 / $1,412.54
| Professional | | $602.56 | $1,000.00 | $1,412.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,122.02 / $1,148.15 / $3,630.78
| Facility | | $1,122.02 | $1,148.15 | $3,630.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,548.82 / $1,548.82 / $1,548.82
| Professional | | $1,548.82 | $1,548.82 | $1,548.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $60.26 / $60.26 / $60.26
| Professional | | $60.26 | $60.26 | $60.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,096.48 / $1,548.82 / $6,025.60
| Facility | | $1,096.48 | $1,548.82 | $6,025.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,047.13 / $1,096.48 / $1,318.26
| Professional | | $1,047.13 | $1,096.48 | $1,318.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $912.01 / $912.01 / $1,318.26
| Professional | | $912.01 | $912.01 | $1,318.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,023.29 / $1,148.15 / $1,949.84
| Professional | | $1,023.29 | $1,148.15 | $1,949.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $467.74 / $467.74 / $776.25
| Professional | | $467.74 | $467.74 | $776.25 |