- 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
- $426.58 / $501.19 / $2,290.87
| Professional | | $426.58 | $501.19 | $2,290.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,818.38 / $7,413.10 / $15,848.93
| Facility | | $2,818.38 | $7,413.10 | $15,848.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $338.84 / $741.31 / $4,677.35
| Professional | | $338.84 | $741.31 | $4,677.35 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $323.59 / $812.83 / $3,715.35
| Facility | | $323.59 | $812.83 | $3,715.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $457.09 / $724.44 / $1,778.28
| Professional | | $457.09 | $724.44 | $1,778.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $524.81 / $2,818.38 / $9,549.93
| Facility | | $524.81 | $2,818.38 | $9,549.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $346.74 / $537.03 / $954.99
| Professional | | $346.74 | $537.03 | $954.99 |