- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,000.00 / $4,786.30 / $11,481.54
| Facility | | $1,000.00 | $4,786.30 | $11,481.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $426.58 / $512.86 / $1,202.26
| Professional | | $426.58 | $512.86 | $1,202.26 |
- 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
- $436.52 / $630.96 / $1,202.26
| Professional | | $436.52 | $630.96 | $1,202.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $831.76 / $1,862.09 / $11,748.98
| Facility | | $831.76 | $1,862.09 | $11,748.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $478.63 / $724.44 / $1,548.82
| Professional | | $478.63 | $724.44 | $1,548.82 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,949.84 / $5,623.41 / $12,302.69
| Facility | | $1,949.84 | $5,623.41 | $12,302.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $407.38 / $562.34 / $1,071.52
| Professional | | $407.38 | $562.34 | $1,071.52 |