- 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
- $1,059.71 / $1,071.58 / $1,952.17
| Professional | | $1,059.71 | $1,071.58 | $1,952.17 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,032.25 / $1,474.09 / $1,883.72
| Professional | | $1,032.25 | $1,474.09 | $1,883.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,146.11 / $1,657.27 / $2,095.09
| Professional | | $1,146.11 | $1,657.27 | $2,095.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.34 / $32.34 / $1,701.92
| Professional | | $32.34 | $32.34 | $1,701.92 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,137.19 / $1,447.33 / $1,629.72
| Facility | | $1,137.19 | $1,447.33 | $1,629.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,314.60 / $1,605.91 / $2,095.09
| Professional | | $1,314.60 | $1,605.91 | $2,095.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,085.00 / $4,262.00 / $17,636.00
| Facility | | $3,085.00 | $4,262.00 | $17,636.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,271.58 / $1,705.20 / $2,538.54
| Professional | | $1,271.58 | $1,705.20 | $2,538.54 |