- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $724.44 / $3,630.78 / $10,000.00
| Professional | | $724.44 | $3,630.78 | $10,000.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $776.25 / $2,754.23 / $6,760.83
| Professional | | $776.25 | $2,754.23 | $6,760.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.36 / $33.11 / $1,737.80
| Professional | | $32.36 | $33.11 | $1,737.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,047.13 / $4,786.30 / $8,912.51
| Professional | | $1,047.13 | $4,786.30 | $8,912.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $891.25 / $3,981.07 / $7,244.36
| Professional | | $891.25 | $3,981.07 | $7,244.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,023.29 / $5,248.07 / $7,585.78
| Professional | | $1,023.29 | $5,248.07 | $7,585.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $741.31 / $1,698.24 / $5,623.41
| Professional | | $741.31 | $1,698.24 | $5,623.41 |