- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $873.00 / $1,836.00 / $11,049.71
| Facility | | $873.00 | $1,836.00 | $11,049.71 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,115.77 / $9,115.77 / $10,027.35
| Facility | | $9,115.77 | $9,115.77 | $10,027.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,709.25 / $2,709.25 / $2,709.25
| Professional | | $2,709.25 | $2,709.25 | $2,709.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,021.01 / $8,021.01 / $8,021.01
| Facility | | $8,021.01 | $8,021.01 | $8,021.01 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,185.00 / $5,800.00 / $14,043.00
| Facility | | $1,185.00 | $5,800.00 | $14,043.00 |