- 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
- $1,918.08 / $2,205.01 / $3,224.01
| Professional | | $1,918.08 | $2,205.01 | $3,224.01 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,445.40 / $2,445.40 / $2,445.40
| Facility | | $2,445.40 | $2,445.40 | $2,445.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,121.89 / $3,150.13 / $3,992.21
| Professional | | $2,121.89 | $3,150.13 | $3,992.21 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.34 / $32.34 / $3,396.15
| Professional | | $32.34 | $32.34 | $3,396.15 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,914.35 / $2,436.44 / $3,220.31
| Facility | | $1,914.35 | $2,436.44 | $3,220.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,346.80 / $3,360.14 / $5,575.83
| Professional | | $2,346.80 | $3,360.14 | $5,575.83 |
- 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
- $2,261.80 / $3,082.59 / $5,016.50
| Professional | | $2,261.80 | $3,082.59 | $5,016.50 |