- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,000.00 / $3,467.37 / $6,760.83
| Facility | | $1,000.00 | $3,467.37 | $6,760.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $794.33 / $870.96 / $1,659.59
| Professional | | $794.33 | $870.96 | $1,659.59 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,623.41 / $8,912.51 / $14,454.40
| Facility | | $5,623.41 | $8,912.51 | $14,454.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $602.56 / $1,202.26 / $1,479.11
| Professional | | $602.56 | $1,202.26 | $1,479.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $870.96 / $1,380.38 / $6,025.60
| Facility | | $870.96 | $1,380.38 | $6,025.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $812.83 / $977.24 / $6,918.31
| Professional | | $812.83 | $977.24 | $6,918.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $891.25 / $3,311.31 / $6,025.60
| Facility | | $891.25 | $3,311.31 | $6,025.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $741.31 / $933.25 / $1,318.26
| Professional | | $741.31 | $933.25 | $1,318.26 |