- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,000.00 / $5,370.32 / $7,943.28
| Facility | | $1,000.00 | $5,370.32 | $7,943.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $549.54 / $691.83 / $1,230.27
| Professional | | $549.54 | $691.83 | $1,230.27 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,047.13 / $2,570.40 / $4,677.35
| Facility | | $1,047.13 | $2,570.40 | $4,677.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $457.09 / $724.44 / $1,096.48
| Professional | | $457.09 | $724.44 | $1,096.48 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $776.25 / $1,122.02 / $1,412.54
| Facility | | $776.25 | $1,122.02 | $1,412.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $512.86 / $776.25 / $1,513.56
| Professional | | $512.86 | $776.25 | $1,513.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $562.34 / $812.83 / $4,466.84
| Professional | | $562.34 | $812.83 | $4,466.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $724.44 / $831.76 / $870.96
| Professional | | $724.44 | $831.76 | $870.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,122.02 / $3,981.07 / $6,918.31
| Facility | | $1,122.02 | $3,981.07 | $6,918.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $501.19 / $676.08 / $1,258.93
| Professional | | $501.19 | $676.08 | $1,258.93 |