- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $288.40 / $28,840.32 / $66,069.34
| Facility | | $288.40 | $28,840.32 | $66,069.34 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,471.29 / $10,471.29 / $10,471.29
| Facility | | $10,471.29 | $10,471.29 | $10,471.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $426.58 / $891.25 / $23,988.33
| Facility | | $426.58 | $891.25 | $23,988.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $416.87 / $416.87 / $575.44
| Professional | | $416.87 | $416.87 | $575.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $245.47 / $331.13 / $575.44
| Facility | | $245.47 | $331.13 | $575.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,479.11 / $6,760.83 / $10,000.00
| Facility | | $1,479.11 | $6,760.83 | $10,000.00 |