- 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
- $975.32 / $1,131.25 / $1,649.33
| Professional | | $975.32 | $1,131.25 | $1,649.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $901.53 / $1,352.25 / $1,926.40
| Professional | | $901.53 | $1,352.25 | $1,926.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,252.98 / $1,252.98 / $1,252.98
| Facility | | $1,252.98 | $1,252.98 | $1,252.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,123.28 / $1,596.06 / $2,033.42
| Professional | | $1,123.28 | $1,596.06 | $2,033.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.34 / $32.34 / $1,741.15
| Professional | | $32.34 | $32.34 | $1,741.15 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $951.68 / $1,228.42 / $1,649.33
| Facility | | $951.68 | $1,228.42 | $1,649.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,223.64 / $1,702.46 / $2,863.17
| Professional | | $1,223.64 | $1,702.46 | $2,863.17 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $755.00 / $5,060.00 / $17,636.00
| Facility | | $755.00 | $5,060.00 | $17,636.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,127.26 / $1,576.44 / $2,553.27
| Professional | | $1,127.26 | $1,576.44 | $2,553.27 |