- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,000.00 / $5,370.32 / $14,454.40
| Facility | | $1,000.00 | $5,370.32 | $14,454.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $371.54 / $457.09 / $1,096.48
| Professional | | $371.54 | $457.09 | $1,096.48 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,162.28 / $6,760.83 / $14,454.40
| Facility | | $3,162.28 | $6,760.83 | $14,454.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $363.08 / $549.54 / $1,047.13
| Professional | | $363.08 | $549.54 | $1,047.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $562.34 / $1,905.46 / $30,199.52
| Facility | | $562.34 | $1,905.46 | $30,199.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $389.05 / $630.96 / $1,288.25
| Professional | | $389.05 | $630.96 | $1,288.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,995.26 / $5,623.41 / $12,882.50
| Facility | | $1,995.26 | $5,623.41 | $12,882.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $354.81 / $512.86 / $933.25
| Professional | | $354.81 | $512.86 | $933.25 |