- 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
- $1,235.17 / $1,415.05 / $2,065.66
| Professional | | $1,235.17 | $1,415.05 | $2,065.66 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,572.50 / $1,572.50 / $1,572.50
| Facility | | $1,572.50 | $1,572.50 | $1,572.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,410.32 / $2,022.25 / $2,559.26
| Professional | | $1,410.32 | $2,022.25 | $2,559.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.34 / $32.34 / $2,186.56
| Professional | | $32.34 | $32.34 | $2,186.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,206.19 / $1,550.40 / $2,072.28
| Facility | | $1,206.19 | $1,550.40 | $2,072.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,550.40 / $2,157.07 / $3,584.40
| Professional | | $1,550.40 | $2,157.07 | $3,584.40 |
- 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
- $1,414.26 / $1,998.36 / $2,903.76
| Professional | | $1,414.26 | $1,998.36 | $2,903.76 |