- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $933.25 / $5,128.61 / $10,964.78
| Facility | | $933.25 | $5,128.61 | $10,964.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,918.31 / $8,709.64 / $12,022.64
| Facility | | $6,918.31 | $8,709.64 | $12,022.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $575.44 / $691.83 / $851.14
| Professional | | $575.44 | $691.83 | $851.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $977.24 / $1,230.27 / $1,513.56
| Professional | | $977.24 | $1,230.27 | $1,513.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $660.69 / $1,000.00 / $1,513.56
| Facility | | $660.69 | $1,000.00 | $1,513.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $616.60 / $891.25 / $11,481.54
| Facility | | $616.60 | $891.25 | $11,481.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,317.64 / $12,882.50 / $29,512.09
| Facility | | $8,317.64 | $12,882.50 | $29,512.09 |