- 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
- $1,521.39 / $1,802.63 / $2,847.66
| Professional | | $1,521.39 | $1,802.63 | $2,847.66 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,646.78 / $2,829.48 / $3,566.73
| Professional | | $1,646.78 | $2,829.48 | $3,566.73 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.34 / $32.34 / $2,444.07
| Professional | | $32.34 | $32.34 | $2,444.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,919.77 / $2,306.10 / $3,566.73
| Professional | | $1,919.77 | $2,306.10 | $3,566.73 |
- 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
- $2,240.28 / $2,840.19 / $3,842.62
| Professional | | $2,240.28 | $2,840.19 | $3,842.62 |