- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,148.15 / $3,090.30 / $8,511.38
| Facility | | $1,148.15 | $3,090.30 | $8,511.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $616.60 / $4,466.84 / $7,244.36
| Professional | | $616.60 | $4,466.84 | $7,244.36 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14,791.08 / $16,595.87 / $19,952.62
| Facility | | $14,791.08 | $16,595.87 | $19,952.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $120.23 / $199.53 / $794.33
| Professional | | $120.23 | $199.53 | $794.33 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $100.00 / $100.00 / $100.00
| Facility | | $100.00 | $100.00 | $100.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,570.40 / $10,000.00 / $25,703.96
| Facility | | $2,570.40 | $10,000.00 | $25,703.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $478.63 / $891.25 / $2,511.89
| Professional | | $478.63 | $891.25 | $2,511.89 |