- 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
- $1,461.54 / $1,464.81 / $2,542.33
| Professional | | $1,461.54 | $1,464.81 | $2,542.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.34 / $445.08 / $2,409.30
| Professional | | $32.34 | $445.08 | $2,409.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,358.42 / $1,728.89 / $2,020.31
| Facility | | $1,358.42 | $1,728.89 | $2,020.31 |
- 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
- $1,681.03 / $2,186.00 / $3,365.40
| Professional | | $1,681.03 | $2,186.00 | $3,365.40 |