- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,000.00 / $7,838.38 / $8,644.27
| Facility | | $1,000.00 | $7,838.38 | $8,644.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,275.73 / $1,319.24 / $2,134.71
| Professional | | $1,275.73 | $1,319.24 | $2,134.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $50.00 / $85.00 / $2,056.07
| Professional | | $50.00 | $85.00 | $2,056.07 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $691.64 / $1,395.28 / $2,134.71
| Facility | | $691.64 | $1,395.28 | $2,134.71 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,035.00 / $15,131.00 / $16,269.00
| Facility | | $1,035.00 | $15,131.00 | $16,269.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,609.66 / $2,041.53 / $3,101.53
| Professional | | $1,609.66 | $2,041.53 | $3,101.53 |