- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,000.00 / $4,897.79 / $11,481.54
| Facility | | $1,000.00 | $4,897.79 | $11,481.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $208.93 / $302.00 / $645.65
| Professional | | $208.93 | $302.00 | $645.65 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,819.70 / $3,715.35 / $5,754.40
| Facility | | $1,819.70 | $3,715.35 | $5,754.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $83.18 / $457.09 / $794.33
| Professional | | $83.18 | $457.09 | $794.33 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $263.03 / $426.58 / $53,703.18
| Facility | | $263.03 | $426.58 | $53,703.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $213.80 / $389.05 / $660.69
| Professional | | $213.80 | $389.05 | $660.69 |