- 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
- $1,340.53 / $1,490.25 / $2,265.71
| Professional | | $1,340.53 | $1,490.25 | $2,265.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,227.27 / $2,124.60 / $2,614.34
| Professional | | $1,227.27 | $2,124.60 | $2,614.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.34 / $398.03 / $2,147.17
| Professional | | $32.34 | $398.03 | $2,147.17 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,371.35 / $1,745.35 / $2,124.73
| Facility | | $1,371.35 | $1,745.35 | $2,124.73 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,628.86 / $2,124.60 / $2,614.34
| Professional | | $1,628.86 | $2,124.60 | $2,614.34 |
- 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
- $1,785.14 / $2,279.98 / $3,178.97
| Professional | | $1,785.14 | $2,279.98 | $3,178.97 |