- 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
- $1,023.29 / $2,137.96 / $10,000.00
| Professional | | $1,023.29 | $2,137.96 | $10,000.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $38,904.51 / $44,668.36 / $53,703.18
| Facility | | $38,904.51 | $44,668.36 | $53,703.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $120.23 / $199.53 / $346.74
| Professional | | $120.23 | $199.53 | $346.74 |
- 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
- $2,454.71 / $18,197.01 / $48,977.88
| Facility | | $2,454.71 | $18,197.01 | $48,977.88 |