- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,105.00 / $3,160.12 / $7,407.00
| Facility | | $1,105.00 | $3,160.12 | $7,407.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,580.57 / $22,632.24 / $45,321.06
| Facility | | $10,580.57 | $22,632.24 | $45,321.06 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $875.00 / $875.00 / $908.00
| Facility | | $875.00 | $875.00 | $908.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,922.02 / $2,902.03 / $6,774.55
| Professional | | $1,922.02 | $2,902.03 | $6,774.55 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $100.00 / $100.00 / $100.00
| Facility | | $100.00 | $100.00 | $100.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,421.00 / $7,842.00 / $21,651.00
| Facility | | $2,421.00 | $7,842.00 | $21,651.00 |