- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,000.00 / $4,897.79 / $11,481.54
| Facility | | $1,000.00 | $4,897.79 | $11,481.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $186.21 / $251.19 / $302.00
| Professional | | $186.21 | $251.19 | $302.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,388.44 / $6,918.31 / $15,135.61
| Facility | | $3,388.44 | $6,918.31 | $15,135.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $234.42 / $316.23 / $549.54
| Professional | | $234.42 | $316.23 | $549.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $549.54 / $549.54 / $4,897.79
| Facility | | $549.54 | $549.54 | $4,897.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $467.74 / $524.81 / $1,412.54
| Professional | | $467.74 | $524.81 | $1,412.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,344.23 / $7,079.46 / $15,488.17
| Facility | | $2,344.23 | $7,079.46 | $15,488.17 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $208.93 / $354.81 / $630.96
| Professional | | $208.93 | $354.81 | $630.96 |