- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,000.00 / $4,570.88 / $11,220.18
| Facility | | $1,000.00 | $4,570.88 | $11,220.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $691.83 / $794.33 / $1,698.24
| Professional | | $691.83 | $794.33 | $1,698.24 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,884.03 / $7,413.10 / $15,135.61
| Facility | | $2,884.03 | $7,413.10 | $15,135.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $691.83 / $1,000.00 / $1,905.46
| Professional | | $691.83 | $1,000.00 | $1,905.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $398.11 / $1,584.89 / $5,623.41
| Facility | | $398.11 | $1,584.89 | $5,623.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $758.58 / $1,122.02 / $2,398.83
| Professional | | $758.58 | $1,122.02 | $2,398.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,884.03 / $8,709.64 / $19,054.61
| Facility | | $2,884.03 | $8,709.64 | $19,054.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $645.65 / $891.25 / $1,698.24
| Professional | | $645.65 | $891.25 | $1,698.24 |