- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,395.28 / $4,387.00 / $9,078.00
| Facility | | $1,395.28 | $4,387.00 | $9,078.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,207.06 / $1,395.28 / $1,408.71
| Professional | | $1,207.06 | $1,395.28 | $1,408.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $30.00 / $45.00 / $60.00
| Professional | | $30.00 | $45.00 | $60.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $19,947.45 / $24,875.82 / $35,712.80
| Facility | | $19,947.45 | $24,875.82 | $35,712.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,413.00 / $1,591.75 / $1,953.15
| Professional | | $1,413.00 | $1,591.75 | $1,953.15 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,680.00 / $4,912.00 / $15,824.00
| Facility | | $1,680.00 | $4,912.00 | $15,824.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,175.92 / $1,452.63 / $2,316.34
| Professional | | $1,175.92 | $1,452.63 | $2,316.34 |