- 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
- $1,177.65 / $1,307.84 / $4,649.00
| Professional | | $1,177.65 | $1,307.84 | $4,649.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,165.20 / $1,571.00 / $2,356.19
| Professional | | $1,165.20 | $1,571.00 | $2,356.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,267.40 / $1,901.10 / $2,398.01
| Professional | | $1,267.40 | $1,901.10 | $2,398.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.34 / $32.34 / $2,028.86
| Professional | | $32.34 | $32.34 | $2,028.86 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,244.70 / $1,576.20 / $2,295.00
| Facility | | $1,244.70 | $1,576.20 | $2,295.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,301.39 / $1,964.47 / $3,180.56
| Professional | | $1,301.39 | $1,964.47 | $3,180.56 |
- 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
- $1,430.35 / $1,836.45 / $2,636.24
| Professional | | $1,430.35 | $1,836.45 | $2,636.24 |