- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $977.24 / $8,709.64 / $16,595.87
| Facility | | $977.24 | $8,709.64 | $16,595.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,818.38 / $4,897.79 / $9,120.11
| Facility | | $2,818.38 | $4,897.79 | $9,120.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $575.44 / $575.44 / $1,621.81
| Facility | | $575.44 | $575.44 | $1,621.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,348.96 / $1,348.96 / $1,348.96
| Professional | | $1,348.96 | $1,348.96 | $1,348.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $707.95 / $912.01 / $1,318.26
| Facility | | $707.95 | $912.01 | $1,318.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,698.24 / $6,760.83 / $10,000.00
| Facility | | $1,698.24 | $6,760.83 | $10,000.00 |