- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,000.00 / $3,388.44 / $9,772.37
| Facility | | $1,000.00 | $3,388.44 | $9,772.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $295.12 / $436.52 / $2,398.83
| Professional | | $295.12 | $436.52 | $2,398.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,089.30 / $5,623.41 / $12,302.69
| Facility | | $2,089.30 | $5,623.41 | $12,302.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $123.03 / $302.00 / $575.44
| Professional | | $123.03 | $302.00 | $575.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $776.25 / $1,584.89 / $4,365.16
| Facility | | $776.25 | $1,584.89 | $4,365.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $549.54 / $660.69 / $1,202.26
| Professional | | $549.54 | $660.69 | $1,202.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $309.03 / $1,174.90 / $3,548.13
| Facility | | $309.03 | $1,174.90 | $3,548.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $309.03 / $501.19 / $933.25
| Professional | | $309.03 | $501.19 | $933.25 |