- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $977.24 / $5,495.41 / $10,000.00
| Facility | | $977.24 | $5,495.41 | $10,000.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,606.93 / $7,413.10 / $9,332.54
| Facility | | $6,606.93 | $7,413.10 | $9,332.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $575.44 / $575.44 / $575.44
| Facility | | $575.44 | $575.44 | $575.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $741.31 / $933.25 / $1,096.48
| Professional | | $741.31 | $933.25 | $1,096.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,122.02 / $1,380.38 / $1,995.26
| Professional | | $1,122.02 | $1,380.38 | $1,995.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $794.33 / $1,148.15 / $1,737.80
| Facility | | $794.33 | $1,148.15 | $1,737.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $776.25 / $1,122.02 / $9,549.93
| Facility | | $776.25 | $1,122.02 | $9,549.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,456.54 / $11,220.18 / $23,988.33
| Facility | | $6,456.54 | $11,220.18 | $23,988.33 |