- 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
- $1,091.11 / $1,158.64 / $2,084.71
| Professional | | $1,091.11 | $1,158.64 | $2,084.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,180.41 / $1,395.58 / $1,988.14
| Professional | | $1,180.41 | $1,395.58 | $1,988.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,193.85 / $1,891.71 / $2,312.62
| Professional | | $1,193.85 | $1,891.71 | $2,312.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.34 / $32.34 / $1,795.09
| Professional | | $32.34 | $32.34 | $1,795.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,282.19 / $1,631.88 / $1,892.46
| Facility | | $1,282.19 | $1,631.88 | $1,892.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,405.43 / $1,694.93 / $2,312.62
| Professional | | $1,405.43 | $1,694.93 | $2,312.62 |
- 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
- $1,377.47 / $1,872.76 / $2,687.57
| Professional | | $1,377.47 | $1,872.76 | $2,687.57 |