- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,000.00 / $7,838.38 / $8,644.27
| Facility | | $1,000.00 | $7,838.38 | $8,644.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,210.79 / $1,310.41 / $7,107.41
| Professional | | $1,210.79 | $1,310.41 | $7,107.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,280.97 / $1,702.06 / $2,585.94
| Professional | | $1,280.97 | $1,702.06 | $2,585.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,386.61 / $2,067.15 / $2,630.67
| Professional | | $1,386.61 | $2,067.15 | $2,630.67 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.34 / $32.34 / $2,191.54
| Professional | | $32.34 | $32.34 | $2,191.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,341.85 / $1,743.57 / $2,936.43
| Facility | | $1,341.85 | $1,743.57 | $2,936.43 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,396.38 / $2,149.25 / $3,406.32
| Professional | | $1,396.38 | $2,149.25 | $3,406.32 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,035.00 / $15,131.00 / $31,244.66
| Facility | | $1,035.00 | $15,131.00 | $31,244.66 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,533.58 / $2,043.30 / $3,260.69
| Professional | | $1,533.58 | $2,043.30 | $3,260.69 |