- 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
- $3,327.55 / $4,768.35 / $8,926.48
| Professional | | $3,327.55 | $4,768.35 | $8,926.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.34 / $32.34 / $7,664.13
| Professional | | $32.34 | $32.34 | $7,664.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,937.09 / $5,010.85 / $5,420.44
| Facility | | $3,937.09 | $5,010.85 | $5,420.44 |
- 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
- $4,310.10 / $6,788.18 / $11,637.24
| Professional | | $4,310.10 | $6,788.18 | $11,637.24 |