- 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
- $1,117.19 / $2,040.53 / $3,610.61
| Professional | | $1,117.19 | $2,040.53 | $3,610.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,152.84 / $2,942.51 / $3,651.18
| Professional | | $2,152.84 | $2,942.51 | $3,651.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $60.00 / $2,146.55 / $4,496.85
| Professional | | $60.00 | $2,146.55 | $4,496.85 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,434.12 / $2,942.51 / $3,651.18
| Professional | | $2,434.12 | $2,942.51 | $3,651.18 |
- 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
- $2,197.78 / $2,777.49 / $4,144.35
| Professional | | $2,197.78 | $2,777.49 | $4,144.35 |