- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,000.00 / $4,897.79 / $11,481.54
| Facility | | $1,000.00 | $4,897.79 | $11,481.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $389.05 / $489.78 / $3,235.94
| Professional | | $389.05 | $489.78 | $3,235.94 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,951.21 / $7,762.47 / $16,982.44
| Facility | | $2,951.21 | $7,762.47 | $16,982.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $239.88 / $660.69 / $2,089.30
| Professional | | $239.88 | $660.69 | $2,089.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $331.13 / $1,258.93 / $3,548.13
| Facility | | $331.13 | $1,258.93 | $3,548.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $416.87 / $794.33 / $1,621.81
| Professional | | $416.87 | $794.33 | $1,621.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $831.76 / $3,162.28 / $10,232.93
| Facility | | $831.76 | $3,162.28 | $10,232.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $316.23 / $478.63 / $954.99
| Professional | | $316.23 | $478.63 | $954.99 |