- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,000.00 / $5,128.61 / $7,762.47
| Facility | | $1,000.00 | $5,128.61 | $7,762.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $602.56 / $977.24 / $2,238.72
| Professional | | $602.56 | $977.24 | $2,238.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $851.14 / $6,918.31 / $13,182.57
| Professional | | $851.14 | $6,918.31 | $13,182.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $758.58 / $1,023.29 / $2,187.76
| Professional | | $758.58 | $1,023.29 | $2,187.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $776.25 / $812.83 / $1,905.46
| Professional | | $776.25 | $812.83 | $1,905.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,073.80 / $16,218.10 / $33,884.42
| Facility | | $4,073.80 | $16,218.10 | $33,884.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $691.83 / $1,023.29 / $2,137.96
| Professional | | $691.83 | $1,023.29 | $2,137.96 |