- 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
- $1,144.72 / $1,306.19 / $1,899.81
| Professional | | $1,144.72 | $1,306.19 | $1,899.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,443.47 / $1,443.47 / $1,443.47
| Facility | | $1,443.47 | $1,443.47 | $1,443.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,294.31 / $1,862.11 / $2,354.76
| Professional | | $1,294.31 | $1,862.11 | $2,354.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.34 / $32.34 / $2,005.44
| Professional | | $32.34 | $32.34 | $2,005.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,106.25 / $1,427.62 / $1,912.85
| Facility | | $1,106.25 | $1,427.62 | $1,912.85 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,427.62 / $1,986.25 / $3,303.39
| Professional | | $1,427.62 | $1,986.25 | $3,303.39 |
- 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
- $1,334.52 / $1,838.47 / $2,706.10
| Professional | | $1,334.52 | $1,838.47 | $2,706.10 |