- 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
- $575.44 / $676.08 / $1,621.81
| Professional | | $575.44 | $676.08 | $1,621.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,454.71 / $6,456.54 / $13,803.84
| Facility | | $2,454.71 | $6,456.54 | $13,803.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $562.34 / $812.83 / $1,584.89
| Professional | | $562.34 | $812.83 | $1,584.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,000.00 / $1,862.09 / $4,786.30
| Facility | | $1,000.00 | $1,862.09 | $4,786.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $630.96 / $933.25 / $2,041.74
| Professional | | $630.96 | $933.25 | $2,041.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,548.82 / $5,248.07 / $12,022.64
| Facility | | $1,548.82 | $5,248.07 | $12,022.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $537.03 / $741.31 / $1,412.54
| Professional | | $537.03 | $741.31 | $1,412.54 |