- 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
- $1,470.78 / $1,564.58 / $3,058.99
| Professional | | $1,470.78 | $1,564.58 | $3,058.99 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,798.23 / $2,621.33 / $3,364.07
| Professional | | $1,798.23 | $2,621.33 | $3,364.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.34 / $538.32 / $2,898.92
| Professional | | $32.34 | $538.32 | $2,898.92 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,581.35 / $2,012.63 / $2,241.62
| Facility | | $1,581.35 | $2,012.63 | $2,241.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,009.69 / $2,621.33 / $3,364.07
| Professional | | $2,009.69 | $2,621.33 | $3,364.07 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,315.00 / $11,259.00 / $12,494.00
| Facility | | $7,315.00 | $11,259.00 | $12,494.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,849.67 / $2,536.23 / $4,192.56
| Professional | | $1,849.67 | $2,536.23 | $4,192.56 |