- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,000.00 / $2,095.00 / $7,838.38
| Facility | | $1,000.00 | $2,095.00 | $7,838.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $937.94 / $1,041.77 / $3,692.00
| Professional | | $937.94 | $1,041.77 | $3,692.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $945.02 / $1,554.12 / $1,883.77
| Professional | | $945.02 | $1,554.12 | $1,883.77 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,003.09 / $1,504.64 / $1,894.28
| Professional | | $1,003.09 | $1,504.64 | $1,894.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.34 / $32.34 / $1,611.66
| Professional | | $32.34 | $32.34 | $1,611.66 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $988.75 / $1,317.67 / $2,210.00
| Facility | | $988.75 | $1,317.67 | $2,210.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,026.96 / $1,554.79 / $2,531.50
| Professional | | $1,026.96 | $1,554.79 | $2,531.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,035.00 / $15,131.00 / $21,396.00
| Facility | | $1,035.00 | $15,131.00 | $21,396.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,093.40 / $1,488.62 / $2,385.91
| Professional | | $1,093.40 | $1,488.62 | $2,385.91 |