- 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
- $234.42 / $380.19 / $562.34
| Professional | | $234.42 | $380.19 | $562.34 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,754.40 / $13,803.84 / $30,199.52
| Facility | | $5,754.40 | $13,803.84 | $30,199.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $125.89 / $177.83 / $512.86
| Professional | | $125.89 | $177.83 | $512.86 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $50,118.72 / $50,118.72 / $53,703.18
| Facility | | $50,118.72 | $50,118.72 | $53,703.18 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $512.86 / $2,818.38 / $9,772.37
| Facility | | $512.86 | $2,818.38 | $9,772.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $389.05 / $588.84 / $1,023.29
| Professional | | $389.05 | $588.84 | $1,023.29 |