- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,000.00 / $3,311.31 / $10,471.29
| Facility | | $1,000.00 | $3,311.31 | $10,471.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $724.44 / $851.14 / $2,089.30
| Professional | | $724.44 | $851.14 | $2,089.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,754.23 / $8,317.64 / $16,218.10
| Facility | | $2,754.23 | $8,317.64 | $16,218.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $741.31 / $1,122.02 / $2,041.74
| Professional | | $741.31 | $1,122.02 | $2,041.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $512.86 / $2,398.83 / $11,481.54
| Facility | | $512.86 | $2,398.83 | $11,481.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $794.33 / $1,230.27 / $2,511.89
| Professional | | $794.33 | $1,230.27 | $2,511.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,884.03 / $8,511.38 / $21,379.62
| Facility | | $2,884.03 | $8,511.38 | $21,379.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $691.83 / $1,000.00 / $1,778.28
| Professional | | $691.83 | $1,000.00 | $1,778.28 |