- 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
- $2,578.44 / $2,974.12 / $4,347.10
| Professional | | $2,578.44 | $2,974.12 | $4,347.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,293.81 / $3,293.81 / $3,293.81
| Facility | | $3,293.81 | $3,293.81 | $3,293.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,977.47 / $4,235.32 / $5,371.92
| Professional | | $2,977.47 | $4,235.32 | $5,371.92 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.34 / $32.34 / $4,571.60
| Professional | | $32.34 | $32.34 | $4,571.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,670.33 / $3,365.60 / $4,341.50
| Facility | | $2,670.33 | $3,365.60 | $4,341.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,214.67 / $4,517.67 / $7,515.06
| Professional | | $3,214.67 | $4,517.67 | $7,515.06 |
- 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
- $3,053.17 / $4,240.50 / $6,754.51
| Professional | | $3,053.17 | $4,240.50 | $6,754.51 |