- 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
- $2,380.27 / $2,455.39 / $4,775.63
| Professional | | $2,380.27 | $2,455.39 | $4,775.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,863.72 / $4,053.44 / $5,245.96
| Professional | | $2,863.72 | $4,053.44 | $5,245.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.34 / $844.64 / $4,525.74
| Professional | | $32.34 | $844.64 | $4,525.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,437.94 / $3,107.64 / $3,635.81
| Facility | | $2,437.94 | $3,107.64 | $3,635.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,107.64 / $4,053.44 / $5,245.96
| Professional | | $3,107.64 | $4,053.44 | $5,245.96 |
- 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
- $2,880.89 / $4,039.56 / $6,677.64
| Professional | | $2,880.89 | $4,039.56 | $6,677.64 |