- 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
- $524.81 / $660.69 / $1,479.11
| Professional | | $524.81 | $660.69 | $1,479.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,454.71 / $6,456.54 / $12,302.69
| Facility | | $2,454.71 | $6,456.54 | $12,302.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $524.81 / $776.25 / $1,513.56
| Professional | | $524.81 | $776.25 | $1,513.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $776.25 / $1,621.81 / $4,677.35
| Facility | | $776.25 | $1,621.81 | $4,677.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $588.84 / $870.96 / $1,995.26
| Professional | | $588.84 | $870.96 | $1,995.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,348.96 / $4,073.80 / $9,549.93
| Facility | | $1,348.96 | $4,073.80 | $9,549.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $501.19 / $707.95 / $1,348.96
| Professional | | $501.19 | $707.95 | $1,348.96 |