- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $758.58 / $5,495.41 / $10,000.00
| Facility | | $758.58 | $5,495.41 | $10,000.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,090.30 / $3,981.07 / $4,466.84
| Facility | | $3,090.30 | $3,981.07 | $4,466.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $489.78 / $575.44 / $741.31
| Professional | | $489.78 | $575.44 | $741.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $707.95 / $794.33 / $812.83
| Professional | | $707.95 | $794.33 | $812.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $524.81 / $724.44 / $1,122.02
| Facility | | $524.81 | $724.44 | $1,122.02 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $467.74 / $758.58 / $8,709.64
| Facility | | $467.74 | $758.58 | $8,709.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,890.45 / $7,244.36 / $14,125.38
| Facility | | $3,890.45 | $7,244.36 | $14,125.38 |