- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,000.00 / $2,000.00 / $3,378.21
| Professional | | $1,000.00 | $2,000.00 | $3,378.21 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,682.40 / $7,610.29 / $9,283.08
| Facility | | $3,682.40 | $7,610.29 | $9,283.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $514.35 / $514.35 / $574.86
| Professional | | $514.35 | $514.35 | $574.86 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,000.00 / $2,120.00 / $4,324.10
| Facility | | $2,000.00 | $2,120.00 | $4,324.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,876.00 / $1,876.00 / $4,040.62
| Professional | | $1,876.00 | $1,876.00 | $4,040.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.34 / $32.34 / $2,814.01
| Professional | | $32.34 | $32.34 | $2,814.01 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,787.97 / $5,088.88 / $9,351.70
| Facility | | $3,787.97 | $5,088.88 | $9,351.70 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,251.58 / $1,305.20 / $1,350.14
| Professional | | $1,251.58 | $1,305.20 | $1,350.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,423.42 / $3,001.99 / $5,372.00
| Professional | | $2,423.42 | $3,001.99 | $5,372.00 |