- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,105.00 / $3,202.46 / $7,407.00
| Facility | | $1,105.00 | $3,202.46 | $7,407.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,903.82 / $23,323.68 / $46,705.66
| Facility | | $10,903.82 | $23,323.68 | $46,705.66 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $875.00 / $14,975.00 / $19,446.00
| Facility | | $875.00 | $14,975.00 | $19,446.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,935.56 / $2,906.23 / $6,754.31
| Professional | | $1,935.56 | $2,906.23 | $6,754.31 |
- 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 |