- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $467.74 / $6,456.54 / $12,882.50
| Facility | | $467.74 | $6,456.54 | $12,882.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,778.28 / $4,466.84 / $9,549.93
| Facility | | $1,778.28 | $4,466.84 | $9,549.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $562.34 / $676.08 / $1,862.09
| Facility | | $562.34 | $676.08 | $1,862.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $489.78 / $489.78 / $562.34
| Professional | | $489.78 | $489.78 | $562.34 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $389.05 / $575.44 / $1,000.00
| Facility | | $389.05 | $575.44 | $1,000.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $933.25 / $10,232.93 / $16,982.44
| Facility | | $933.25 | $10,232.93 | $16,982.44 |