- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $512.45 / $5,428.00 / $10,651.00
| Facility | | $512.45 | $5,428.00 | $10,651.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,427.00 / $7,478.00 / $13,989.00
| Facility | | $4,427.00 | $7,478.00 | $13,989.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,261.85 / $2,261.85 / $7,124.94
| Facility | | $2,261.85 | $2,261.85 | $7,124.94 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $512.45 / $676.57 / $912.16
| Facility | | $512.45 | $676.57 | $912.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $558.12 / $735.70 / $1,014.76
| Professional | | $558.12 | $735.70 | $1,014.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,804.00 / $8,698.00 / $15,722.00
| Facility | | $3,804.00 | $8,698.00 | $15,722.00 |