- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $977.24 / $2,570.40 / $6,760.83
| Facility | | $977.24 | $2,570.40 | $6,760.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,677.35 / $4,677.35 / $4,677.35
| Facility | | $4,677.35 | $4,677.35 | $4,677.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $549.54 / $954.99 / $1,819.70
| Professional | | $549.54 | $954.99 | $1,819.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $602.56 / $1,288.25 / $9,120.11
| Facility | | $602.56 | $1,288.25 | $9,120.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,000.00 / $1,348.96 / $1,584.89
| Professional | | $1,000.00 | $1,348.96 | $1,584.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,677.35 / $4,677.35 / $4,677.35
| Facility | | $4,677.35 | $4,677.35 | $4,677.35 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,715.35 / $7,762.47 / $10,715.19
| Facility | | $3,715.35 | $7,762.47 | $10,715.19 |