- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,000.00 / $10,715.19 / $14,125.38
| Facility | | $1,000.00 | $10,715.19 | $14,125.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $302.00 / $457.09 / $1,659.59
| Professional | | $302.00 | $457.09 | $1,659.59 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,096.48 / $1,096.48 / $1,445.44
| Professional | | $1,096.48 | $1,096.48 | $1,445.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $309.03 / $457.09 / $2,344.23
| Facility | | $309.03 | $457.09 | $2,344.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $707.95 / $1,047.13 / $1,412.54
| Professional | | $707.95 | $1,047.13 | $1,412.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $851.14 / $1,412.54 / $1,949.84
| Professional | | $851.14 | $1,412.54 | $1,949.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $302.00 / $478.63 / $2,344.23
| Facility | | $302.00 | $478.63 | $2,344.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $60.26 / $616.60 / $1,412.54
| Professional | | $60.26 | $616.60 | $1,412.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $575.44 / $1,148.15 / $1,737.80
| Professional | | $575.44 | $1,148.15 | $1,737.80 |