- 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
- $2,653.10 / $2,832.11 / $3,972.34
| Professional | | $2,653.10 | $2,832.11 | $3,972.34 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,064.82 / $3,064.82 / $3,064.82
| Facility | | $3,064.82 | $3,064.82 | $3,064.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,683.63 / $3,962.23 / $5,185.78
| Professional | | $2,683.63 | $3,962.23 | $5,185.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.34 / $32.34 / $4,176.37
| Professional | | $32.34 | $32.34 | $4,176.37 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,035.19 / $3,029.15 / $3,972.34
| Facility | | $2,035.19 | $3,029.15 | $3,972.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,909.47 / $4,330.51 / $7,151.40
| Professional | | $2,909.47 | $4,330.51 | $7,151.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $755.00 / $4,616.00 / $17,636.00
| Facility | | $755.00 | $4,616.00 | $17,636.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,972.12 / $3,946.99 / $5,819.02
| Professional | | $2,972.12 | $3,946.99 | $5,819.02 |