- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,621.81 / $7,244.36 / $19,054.61
| Facility | | $1,621.81 | $7,244.36 | $19,054.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,000.00 / $1,288.25 / $4,786.30
| Professional | | $1,000.00 | $1,288.25 | $4,786.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,265.80 / $11,748.98 / $27,542.29
| Facility | | $4,265.80 | $11,748.98 | $27,542.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,000.00 / $1,513.56 / $2,754.23
| Professional | | $1,000.00 | $1,513.56 | $2,754.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,905.46 / $4,466.84 / $13,489.63
| Facility | | $1,905.46 | $4,466.84 | $13,489.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,071.52 / $1,698.24 / $3,548.13
| Professional | | $1,071.52 | $1,698.24 | $3,548.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,019.95 / $9,120.11 / $20,892.96
| Facility | | $3,019.95 | $9,120.11 | $20,892.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,000.00 / $1,412.54 / $2,570.40
| Professional | | $1,000.00 | $1,412.54 | $2,570.40 |