- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $977.24 / $5,370.32 / $9,772.37
| Facility | | $977.24 | $5,370.32 | $9,772.37 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,888.44 / $6,760.83 / $7,413.10
| Facility | | $5,888.44 | $6,760.83 | $7,413.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $660.69 / $794.33 / $977.24
| Professional | | $660.69 | $794.33 | $977.24 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $977.24 / $1,202.26 / $1,737.80
| Professional | | $977.24 | $1,202.26 | $1,737.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $758.58 / $1,071.52 / $1,737.80
| Facility | | $758.58 | $1,071.52 | $1,737.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $676.08 / $1,000.00 / $10,000.00
| Facility | | $676.08 | $1,000.00 | $10,000.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,623.41 / $9,549.93 / $19,054.61
| Facility | | $5,623.41 | $9,549.93 | $19,054.61 |