- 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
- $1,065.82 / $1,237.10 / $1,803.08
| Professional | | $1,065.82 | $1,237.10 | $1,803.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,373.52 / $1,373.52 / $1,373.52
| Facility | | $1,373.52 | $1,373.52 | $1,373.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,232.61 / $1,744.51 / $2,222.98
| Professional | | $1,232.61 | $1,744.51 | $2,222.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.34 / $32.34 / $1,910.44
| Professional | | $32.34 | $32.34 | $1,910.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,050.20 / $1,347.86 / $1,803.08
| Facility | | $1,050.20 | $1,347.86 | $1,803.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,337.46 / $1,860.81 / $3,132.87
| Professional | | $1,337.46 | $1,860.81 | $3,132.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $755.00 / $4,616.00 / $17,636.00
| Facility | | $755.00 | $4,616.00 | $17,636.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,237.30 / $1,739.50 / $2,563.03
| Professional | | $1,237.30 | $1,739.50 | $2,563.03 |