- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $912.01 / $2,884.03 / $9,772.37
| Facility | | $912.01 | $2,884.03 | $9,772.37 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,471.29 / $26,915.35 / $35,481.34
| Facility | | $10,471.29 | $26,915.35 | $35,481.34 |
- 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
- $831.76 / $1,318.26 / $4,897.79
| Professional | | $831.76 | $1,318.26 | $4,897.79 |
- 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
- $3,981.07 / $14,125.38 / $38,018.94
| Facility | | $3,981.07 | $14,125.38 | $38,018.94 |