- 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
- $1,622.70 / $1,759.31 / $3,380.14
| Professional | | $1,622.70 | $1,759.31 | $3,380.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,985.61 / $2,947.22 / $3,713.36
| Professional | | $1,985.61 | $2,947.22 | $3,713.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.34 / $595.08 / $3,203.28
| Professional | | $32.34 | $595.08 | $3,203.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,865.38 / $2,374.12 / $2,681.29
| Facility | | $1,865.38 | $2,374.12 | $2,681.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,259.54 / $2,947.22 / $3,713.36
| Professional | | $2,259.54 | $2,947.22 | $3,713.36 |
- 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
- $2,215.48 / $2,805.25 / $4,637.24
| Professional | | $2,215.48 | $2,805.25 | $4,637.24 |