- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,000.00 / $4,570.88 / $11,481.54
| Facility | | $1,000.00 | $4,570.88 | $11,481.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $676.08 / $851.14 / $1,659.59
| Professional | | $676.08 | $851.14 | $1,659.59 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,388.44 / $8,912.51 / $16,982.44
| Facility | | $3,388.44 | $8,912.51 | $16,982.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $676.08 / $977.24 / $1,819.70
| Professional | | $676.08 | $977.24 | $1,819.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $398.11 / $1,905.46 / $5,370.32
| Facility | | $398.11 | $1,905.46 | $5,370.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $707.95 / $1,148.15 / $2,454.71
| Professional | | $707.95 | $1,148.15 | $2,454.71 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,905.46 / $5,623.41 / $12,302.69
| Facility | | $1,905.46 | $5,623.41 | $12,302.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $645.65 / $912.01 / $1,698.24
| Professional | | $645.65 | $912.01 | $1,698.24 |