- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,000.00 / $4,466.84 / $11,220.18
| Facility | | $1,000.00 | $4,466.84 | $11,220.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $724.44 / $870.96 / $1,778.28
| Professional | | $724.44 | $870.96 | $1,778.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,311.31 / $8,511.38 / $16,218.10
| Facility | | $3,311.31 | $8,511.38 | $16,218.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $707.95 / $1,023.29 / $1,905.46
| Professional | | $707.95 | $1,023.29 | $1,905.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $812.83 / $2,089.30 / $5,623.41
| Facility | | $812.83 | $2,089.30 | $5,623.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $758.58 / $1,202.26 / $2,570.40
| Professional | | $758.58 | $1,202.26 | $2,570.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,548.82 / $4,265.80 / $10,232.93
| Facility | | $1,548.82 | $4,265.80 | $10,232.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $676.08 / $977.24 / $1,819.70
| Professional | | $676.08 | $977.24 | $1,819.70 |