- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,000.00 / $1,348.96 / $3,981.07
| Facility | | $1,000.00 | $1,348.96 | $3,981.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $933.25 / $1,047.13 / $1,698.24
| Professional | | $933.25 | $1,047.13 | $1,698.24 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $870.96 / $870.96 / $3,548.13
| Facility | | $870.96 | $870.96 | $3,548.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,621.81 / $1,621.81 / $1,949.84
| Professional | | $1,621.81 | $1,621.81 | $1,949.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,000.00 / $1,348.96 / $2,344.23
| Facility | | $1,000.00 | $1,348.96 | $2,344.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $562.34 / $562.34 / $5,011.87
| Professional | | $562.34 | $562.34 | $5,011.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $562.34 / $1,348.96 / $1,621.81
| Facility | | $562.34 | $1,348.96 | $1,621.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $562.34 / $562.34 / $891.25
| Professional | | $562.34 | $562.34 | $891.25 |