- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $537.03 / $4,897.79 / $10,000.00
| Facility | | $537.03 | $4,897.79 | $10,000.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,772.37 / $11,220.18 / $12,302.69
| Facility | | $9,772.37 | $11,220.18 | $12,302.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $407.38 / $512.86 / $1,288.25
| Professional | | $407.38 | $512.86 | $1,288.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $676.08 / $851.14 / $1,047.13
| Professional | | $676.08 | $851.14 | $1,047.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $467.74 / $660.69 / $1,000.00
| Facility | | $467.74 | $660.69 | $1,000.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $426.58 / $616.60 / $10,000.00
| Facility | | $426.58 | $616.60 | $10,000.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,760.83 / $11,481.54 / $23,988.33
| Facility | | $6,760.83 | $11,481.54 | $23,988.33 |