- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $371.54 / $2,630.27 / $8,912.51
| Facility | | $371.54 | $2,630.27 | $8,912.51 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $57,543.99 / $64,565.42 / $70,794.58
| Facility | | $57,543.99 | $64,565.42 | $70,794.58 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $416.87 / $416.87 / $416.87
| Facility | | $416.87 | $416.87 | $416.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $281.84 / $363.08 / $426.58
| Professional | | $281.84 | $363.08 | $426.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $389.05 / $489.78 / $776.25
| Professional | | $389.05 | $489.78 | $776.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $288.40 / $398.11 / $630.96
| Facility | | $288.40 | $398.11 | $630.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $288.40 / $407.38 / $10,000.00
| Facility | | $288.40 | $407.38 | $10,000.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,471.29 / $24,547.09 / $48,977.88
| Facility | | $10,471.29 | $24,547.09 | $48,977.88 |