- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,202.26 / $6,025.60 / $16,595.87
| Facility | | $1,202.26 | $6,025.60 | $16,595.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,548.82 / $3,715.35 / $6,918.31
| Facility | | $1,548.82 | $3,715.35 | $6,918.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $501.19 / $776.25 / $1,380.38
| Facility | | $501.19 | $776.25 | $1,380.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $741.31 / $741.31 / $1,047.13
| Professional | | $741.31 | $741.31 | $1,047.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $436.52 / $602.56 / $1,000.00
| Facility | | $436.52 | $602.56 | $1,000.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,479.11 / $6,760.83 / $10,000.00
| Facility | | $1,479.11 | $6,760.83 | $10,000.00 |