- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,000.00 / $3,715.35 / $9,772.37
| Facility | | $1,000.00 | $3,715.35 | $9,772.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $602.56 / $724.44 / $1,698.24
| Professional | | $602.56 | $724.44 | $1,698.24 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $933.25 / $2,818.38 / $10,715.19
| Facility | | $933.25 | $2,818.38 | $10,715.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $616.60 / $912.01 / $1,737.80
| Professional | | $616.60 | $912.01 | $1,737.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $691.83 / $1,584.89 / $5,011.87
| Facility | | $691.83 | $1,584.89 | $5,011.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $660.69 / $1,023.29 / $2,238.72
| Professional | | $660.69 | $1,023.29 | $2,238.72 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,949.84 / $5,495.41 / $12,302.69
| Facility | | $1,949.84 | $5,495.41 | $12,302.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $575.44 / $812.83 / $1,513.56
| Professional | | $575.44 | $812.83 | $1,513.56 |