- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,258.93 / $5,248.07 / $14,454.40
| Facility | | $1,258.93 | $5,248.07 | $14,454.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $794.33 / $6,456.54 / $9,332.54
| Professional | | $794.33 | $6,456.54 | $9,332.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $19,498.45 / $26,302.68 / $31,622.78
| Facility | | $19,498.45 | $26,302.68 | $31,622.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $120.23 / $199.53 / $1,174.90
| Professional | | $120.23 | $199.53 | $1,174.90 |
- 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
- $707.95 / $1,096.48 / $2,630.27
| Professional | | $707.95 | $1,096.48 | $2,630.27 |