- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,000.00 / $10,964.78 / $16,595.87
| Facility | | $1,000.00 | $10,964.78 | $16,595.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $309.03 / $354.81 / $1,548.82
| Professional | | $309.03 | $354.81 | $1,548.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,071.52 / $1,071.52 / $1,071.52
| Professional | | $1,071.52 | $1,071.52 | $1,071.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $331.13 / $426.58 / $2,187.76
| Facility | | $331.13 | $426.58 | $2,187.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $549.54 / $954.99 / $2,238.72
| Professional | | $549.54 | $954.99 | $2,238.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,380.38 / $1,380.38 / $1,862.09
| Professional | | $1,380.38 | $1,380.38 | $1,862.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $426.58 / $1,548.82 / $2,238.72
| Facility | | $426.58 | $1,548.82 | $2,238.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $60.26 / $295.12 / $1,071.52
| Professional | | $60.26 | $295.12 | $1,071.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $812.83 / $870.96 / $1,862.09
| Professional | | $812.83 | $870.96 | $1,862.09 |