- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $933.25 / $7,079.46 / $14,454.40
| Facility | | $933.25 | $7,079.46 | $14,454.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,511.38 / $11,220.18 / $21,877.62
| Facility | | $8,511.38 | $11,220.18 | $21,877.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $457.09 / $933.25 / $9,772.37
| Facility | | $457.09 | $933.25 | $9,772.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,000.00 / $1,023.29 / $1,412.54
| Professional | | $1,000.00 | $1,023.29 | $1,412.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,918.31 / $8,128.31 / $10,000.00
| Facility | | $6,918.31 | $8,128.31 | $10,000.00 |