- 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
- $2,784.98 / $2,885.78 / $4,838.38
| Professional | | $2,784.98 | $2,885.78 | $4,838.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.34 / $849.55 / $4,585.21
| Professional | | $32.34 | $849.55 | $4,585.21 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,351.06 / $3,221.89 / $3,853.22
| Facility | | $2,351.06 | $3,221.89 | $3,853.22 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,085.00 / $4,262.00 / $17,636.00
| Facility | | $3,085.00 | $4,262.00 | $17,636.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,175.65 / $4,178.00 / $6,675.50
| Professional | | $3,175.65 | $4,178.00 | $6,675.50 |