- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,040.00 / $1,728.00 / $2,377.00
| Facility | | $1,040.00 | $1,728.00 | $2,377.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,354.01 / $1,984.30 / $2,244.48
| Professional | | $1,354.01 | $1,984.30 | $2,244.48 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $17,484.66 / $21,218.47 / $28,545.63
| Facility | | $17,484.66 | $21,218.47 | $28,545.63 |
- 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
- $1,726.89 / $2,187.39 / $3,851.62
| Professional | | $1,726.89 | $2,187.39 | $3,851.62 |