- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,023.29 / $2,630.27 / $7,762.47
| Facility | | $1,023.29 | $2,630.27 | $7,762.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,023.29 / $1,698.24 / $10,000.00
| Professional | | $1,023.29 | $1,698.24 | $10,000.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,120.11 / $15,488.17 / $18,197.01
| Facility | | $9,120.11 | $15,488.17 | $18,197.01 |
- 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
- $1,737.80 / $7,762.47 / $16,982.44
| Facility | | $1,737.80 | $7,762.47 | $16,982.44 |