- 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
- $1,011.45 / $1,087.34 / $2,092.84
| Professional | | $1,011.45 | $1,087.34 | $2,092.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,232.78 / $1,799.45 / $2,281.73
| Professional | | $1,232.78 | $1,799.45 | $2,281.73 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.34 / $367.42 / $1,983.34
| Professional | | $32.34 | $367.42 | $1,983.34 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,065.51 / $1,379.58 / $1,683.62
| Facility | | $1,065.51 | $1,379.58 | $1,683.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,379.58 / $1,799.45 / $2,281.73
| Professional | | $1,379.58 | $1,799.45 | $2,281.73 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,085.00 / $3,085.00 / $4,616.00
| Facility | | $3,085.00 | $3,085.00 | $4,616.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,398.40 / $1,761.01 / $2,852.82
| Professional | | $1,398.40 | $1,761.01 | $2,852.82 |