- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $831.76 / $2,884.03 / $9,772.37
| Facility | | $831.76 | $2,884.03 | $9,772.37 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,760.83 / $16,982.44 / $22,387.21
| Facility | | $6,760.83 | $16,982.44 | $22,387.21 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,890.45 / $6,918.31 / $7,413.10
| Facility | | $3,890.45 | $6,918.31 | $7,413.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $537.03 / $870.96 / $2,344.23
| Professional | | $537.03 | $870.96 | $2,344.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $100.00 / $100.00 / $100.00
| Facility | | $100.00 | $100.00 | $100.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,311.31 / $9,772.37 / $25,703.96
| Facility | | $3,311.31 | $9,772.37 | $25,703.96 |