- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $977.24 / $4,265.80 / $10,964.78
| Facility | | $977.24 | $4,265.80 | $10,964.78 |
- 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
- Professional
- Modifier
- Low / Median / High Price
- $660.69 / $831.76 / $2,089.30
| Professional | | $660.69 | $831.76 | $2,089.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $724.44 / $954.99 / $1,819.70
| Professional | | $724.44 | $954.99 | $1,819.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $691.83 / $1,023.29 / $1,584.89
| Facility | | $691.83 | $1,023.29 | $1,584.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $630.96 / $1,071.52 / $10,000.00
| Facility | | $630.96 | $1,071.52 | $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 |