- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,000.00 / $4,365.16 / $10,964.78
| Facility | | $1,000.00 | $4,365.16 | $10,964.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $645.65 / $741.31 / $1,659.59
| Professional | | $645.65 | $741.31 | $1,659.59 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,818.38 / $7,244.36 / $15,135.61
| Facility | | $2,818.38 | $7,244.36 | $15,135.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $630.96 / $933.25 / $1,737.80
| Professional | | $630.96 | $933.25 | $1,737.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $870.96 / $1,862.09 / $5,623.41
| Facility | | $870.96 | $1,862.09 | $5,623.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $707.95 / $1,047.13 / $2,238.72
| Professional | | $707.95 | $1,047.13 | $2,238.72 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,019.95 / $8,709.64 / $19,054.61
| Facility | | $3,019.95 | $8,709.64 | $19,054.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $602.56 / $851.14 / $1,584.89
| Professional | | $602.56 | $851.14 | $1,584.89 |