- 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
- $602.56 / $724.44 / $1,621.81
| Professional | | $602.56 | $724.44 | $1,621.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,818.38 / $7,079.46 / $14,454.40
| Facility | | $2,818.38 | $7,079.46 | $14,454.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $562.34 / $851.14 / $1,621.81
| Professional | | $562.34 | $851.14 | $1,621.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $831.76 / $1,862.09 / $5,128.61
| Facility | | $831.76 | $1,862.09 | $5,128.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $645.65 / $977.24 / $2,187.76
| Professional | | $645.65 | $977.24 | $2,187.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,949.84 / $5,495.41 / $12,302.69
| Facility | | $1,949.84 | $5,495.41 | $12,302.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $549.54 / $776.25 / $1,445.44
| Professional | | $549.54 | $776.25 | $1,445.44 |