- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,000.00 / $5,248.07 / $13,182.57
| Facility | | $1,000.00 | $5,248.07 | $13,182.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $81.28 / $1,548.82 / $3,019.95
| Professional | | $81.28 | $1,548.82 | $3,019.95 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,570.40 / $5,248.07 / $14,454.40
| Facility | | $2,570.40 | $5,248.07 | $14,454.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $77.62 / $1,698.24 / $4,168.69
| Professional | | $77.62 | $1,698.24 | $4,168.69 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $77.62 / $1,949.84 / $7,943.28
| Facility | | $77.62 | $1,949.84 | $7,943.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $83.18 / $1,174.90 / $4,570.88
| Professional | | $83.18 | $1,174.90 | $4,570.88 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,238.72 / $6,918.31 / $15,488.17
| Facility | | $2,238.72 | $6,918.31 | $15,488.17 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $72.44 / $1,202.26 / $3,630.78
| Professional | | $72.44 | $1,202.26 | $3,630.78 |