- 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
- $1,443.19 / $1,561.60 / $2,294.13
| Professional | | $1,443.19 | $1,561.60 | $2,294.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,744.15 / $1,744.15 / $1,744.15
| Facility | | $1,744.15 | $1,744.15 | $1,744.15 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,583.86 / $2,373.67 / $3,093.83
| Professional | | $1,583.86 | $2,373.67 | $3,093.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.34 / $32.34 / $2,419.07
| Professional | | $32.34 | $32.34 | $2,419.07 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,443.19 / $1,744.15 / $2,425.98
| Facility | | $1,443.19 | $1,744.15 | $2,425.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,773.86 / $2,568.71 / $3,955.89
| Professional | | $1,773.86 | $2,568.71 | $3,955.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,085.00 / $4,616.00 / $15,732.00
| Facility | | $3,085.00 | $4,616.00 | $15,732.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,618.62 / $2,466.73 / $3,398.24
| Professional | | $1,618.62 | $2,466.73 | $3,398.24 |