- 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
- $2,346.16 / $2,386.83 / $4,098.66
| Professional | | $2,346.16 | $2,386.83 | $4,098.66 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,511.71 / $3,680.42 / $4,729.22
| Professional | | $2,511.71 | $3,680.42 | $4,729.22 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.34 / $724.07 / $3,884.19
| Professional | | $32.34 | $724.07 | $3,884.19 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,234.94 / $2,844.48 / $3,674.70
| Facility | | $2,234.94 | $2,844.48 | $3,674.70 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,854.11 / $3,722.75 / $4,729.22
| Professional | | $2,854.11 | $3,722.75 | $4,729.22 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,085.00 / $3,503.00 / $15,732.00
| Facility | | $3,085.00 | $3,503.00 | $15,732.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,877.75 / $3,937.43 / $5,798.77
| Professional | | $2,877.75 | $3,937.43 | $5,798.77 |