- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,000.00 / $3,715.35 / $9,772.37
| Facility | | $1,000.00 | $3,715.35 | $9,772.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $616.60 / $724.44 / $1,318.26
| Professional | | $616.60 | $724.44 | $1,318.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,819.70 / $5,128.61 / $13,803.84
| Facility | | $1,819.70 | $5,128.61 | $13,803.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $512.86 / $724.44 / $1,412.54
| Professional | | $512.86 | $724.44 | $1,412.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $512.86 / $1,778.28 / $5,888.44
| Facility | | $512.86 | $1,778.28 | $5,888.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $537.03 / $870.96 / $1,862.09
| Professional | | $537.03 | $870.96 | $1,862.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,737.80 / $6,456.54 / $15,848.93
| Facility | | $1,737.80 | $6,456.54 | $15,848.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $537.03 / $741.31 / $1,348.96
| Professional | | $537.03 | $741.31 | $1,348.96 |