- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,000.00 / $7,838.38 / $7,838.38
| Facility | | $1,000.00 | $7,838.38 | $7,838.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,195.40 / $1,278.64 / $3,091.44
| Professional | | $1,195.40 | $1,278.64 | $3,091.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,242.33 / $1,972.54 / $2,471.42
| Professional | | $1,242.33 | $1,972.54 | $2,471.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.34 / $355.21 / $1,895.28
| Professional | | $32.34 | $355.21 | $1,895.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,019.56 / $1,673.83 / $1,754.63
| Facility | | $1,019.56 | $1,673.83 | $1,754.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,486.27 / $1,972.54 / $2,471.42
| Professional | | $1,486.27 | $1,972.54 | $2,471.42 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,315.00 / $11,259.00 / $12,494.00
| Facility | | $7,315.00 | $11,259.00 | $12,494.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,476.50 / $2,008.53 / $3,267.36
| Professional | | $1,476.50 | $2,008.53 | $3,267.36 |