- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $960.00 / $1,268.00 / $2,250.00
| Facility | | $960.00 | $1,268.00 | $2,250.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,016.56 / $1,117.89 / $1,264.58
| Professional | | $1,016.56 | $1,117.89 | $1,264.58 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13,455.92 / $16,329.40 / $21,968.27
| Facility | | $13,455.92 | $16,329.40 | $21,968.27 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,654.00 / $10,048.00 / $10,551.00
| Facility | | $4,654.00 | $10,048.00 | $10,551.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $650.00 / $1,754.00 / $5,201.00
| Facility | | $650.00 | $1,754.00 | $5,201.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,090.54 / $1,526.75 / $2,282.86
| Professional | | $1,090.54 | $1,526.75 | $2,282.86 |