- 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
- $3,291.46 / $3,361.74 / $6,308.18
| Professional | | $3,291.46 | $3,361.74 | $6,308.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,656.43 / $5,380.13 / $6,702.93
| Professional | | $3,656.43 | $5,380.13 | $6,702.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.34 / $32.34 / $5,446.78
| Professional | | $32.34 | $32.34 | $5,446.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,124.77 / $5,151.75 / $6,702.93
| Professional | | $4,124.77 | $5,151.75 | $6,702.93 |
- 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
- $4,333.12 / $5,454.27 / $7,331.76
| Professional | | $4,333.12 | $5,454.27 | $7,331.76 |