- 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
- $1,609.16 / $1,860.81 / $2,722.31
| Professional | | $1,609.16 | $1,860.81 | $2,722.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,068.42 / $2,068.42 / $2,068.42
| Facility | | $2,068.42 | $2,068.42 | $2,068.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,854.77 / $2,647.52 / $3,362.92
| Professional | | $1,854.77 | $2,647.52 | $3,362.92 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.34 / $32.34 / $2,876.85
| Professional | | $32.34 | $32.34 | $2,876.85 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,628.82 / $2,073.05 / $2,722.31
| Facility | | $1,628.82 | $2,073.05 | $2,722.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,029.76 / $2,824.02 / $4,712.79
| Professional | | $2,029.76 | $2,824.02 | $4,712.79 |
- 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
- $1,861.04 / $2,608.08 / $4,232.82
| Professional | | $1,861.04 | $2,608.08 | $4,232.82 |