- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $741.31 / $3,467.37 / $23,988.33
| Facility | | $741.31 | $3,467.37 | $23,988.33 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,230.27 / $3,311.31 / $6,025.60
| Facility | | $1,230.27 | $3,311.31 | $6,025.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,311.31 / $3,715.35 / $5,248.07
| Facility | | $3,311.31 | $3,715.35 | $5,248.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,238.72 / $2,511.89 / $3,890.45
| Professional | | $2,238.72 | $2,511.89 | $3,890.45 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,412.54 / $1,862.09 / $1,862.09
| Facility | | $1,412.54 | $1,862.09 | $1,862.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $575.44 / $3,311.31 / $10,000.00
| Facility | | $575.44 | $3,311.31 | $10,000.00 |