- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,000.00 / $5,248.07 / $13,489.63
| Facility | | $1,000.00 | $5,248.07 | $13,489.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $588.84 / $794.33 / $1,659.59
| Professional | | $588.84 | $794.33 | $1,659.59 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,754.23 / $6,456.54 / $12,589.25
| Facility | | $2,754.23 | $6,456.54 | $12,589.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $602.56 / $831.76 / $1,621.81
| Professional | | $602.56 | $831.76 | $1,621.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,047.13 / $2,454.71 / $5,888.44
| Facility | | $1,047.13 | $2,454.71 | $5,888.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $660.69 / $1,023.29 / $2,137.96
| Professional | | $660.69 | $1,023.29 | $2,137.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,000.00 / $2,884.03 / $6,309.57
| Facility | | $1,000.00 | $2,884.03 | $6,309.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $562.34 / $831.76 / $1,548.82
| Professional | | $562.34 | $831.76 | $1,548.82 |