- 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
- $1,153.52 / $1,342.14 / $1,960.48
| Professional | | $1,153.52 | $1,342.14 | $1,960.48 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,489.16 / $1,489.16 / $1,489.16
| Facility | | $1,489.16 | $1,489.16 | $1,489.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,335.66 / $1,895.57 / $2,424.46
| Professional | | $1,335.66 | $1,895.57 | $2,424.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.34 / $32.34 / $2,071.21
| Professional | | $32.34 | $32.34 | $2,071.21 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,191.46 / $1,516.40 / $1,960.48
| Facility | | $1,191.46 | $1,516.40 | $1,960.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,453.27 / $2,024.60 / $3,397.35
| Professional | | $1,453.27 | $2,024.60 | $3,397.35 |
- 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
- $1,376.65 / $1,912.00 / $3,054.14
| Professional | | $1,376.65 | $1,912.00 | $3,054.14 |