- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $707.95 / $1,479.11 / $14,454.40
| Facility | | $707.95 | $1,479.11 | $14,454.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,481.54 / $15,488.17 / $26,302.68
| Facility | | $11,481.54 | $15,488.17 | $26,302.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,862.09 / $2,187.76 / $3,715.35
| Facility | | $1,862.09 | $2,187.76 | $3,715.35 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $724.44 / $1,479.11 / $6,918.31
| Facility | | $724.44 | $1,479.11 | $6,918.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $741.31 / $1,548.82 / $15,135.61
| Facility | | $741.31 | $1,548.82 | $15,135.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,047.13 / $1,584.89 / $2,398.83
| Professional | | $1,047.13 | $1,584.89 | $2,398.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,000.00 / $18,620.87 / $27,542.29
| Facility | | $10,000.00 | $18,620.87 | $27,542.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,585.78 / $12,302.69 / $16,595.87
| Facility | | $7,585.78 | $12,302.69 | $16,595.87 |