- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $960.00 / $1,813.00 / $3,412.00
| Facility | | $960.00 | $1,813.00 | $3,412.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $661.49 / $686.89 / $776.81
| Professional | | $661.49 | $686.89 | $776.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,049.26 / $13,408.80 / $18,039.12
| Facility | | $11,049.26 | $13,408.80 | $18,039.12 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,500.00 / $12,315.00 / $28,754.00
| Facility | | $1,500.00 | $12,315.00 | $28,754.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $734.33 / $976.77 / $1,485.64
| Professional | | $734.33 | $976.77 | $1,485.64 |