- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,000.00 / $4,365.16 / $10,715.19
| Facility | | $1,000.00 | $4,365.16 | $10,715.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $616.60 / $724.44 / $1,513.56
| Professional | | $616.60 | $724.44 | $1,513.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,754.23 / $7,079.46 / $14,454.40
| Facility | | $2,754.23 | $7,079.46 | $14,454.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $478.63 / $758.58 / $1,659.59
| Professional | | $478.63 | $758.58 | $1,659.59 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $758.58 / $1,819.70 / $5,011.87
| Facility | | $758.58 | $1,819.70 | $5,011.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $549.54 / $977.24 / $2,187.76
| Professional | | $549.54 | $977.24 | $2,187.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,000.00 / $2,951.21 / $6,760.83
| Facility | | $1,000.00 | $2,951.21 | $6,760.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $467.74 / $741.31 / $1,513.56
| Professional | | $467.74 | $741.31 | $1,513.56 |