- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,554.01 / $3,911.31 / $20,038.52
| Facility | | $1,554.01 | $3,911.31 | $20,038.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $17,512.20 / $25,879.71 / $40,738.61
| Facility | | $17,512.20 | $25,879.71 | $40,738.61 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $875.00 / $26,502.00 / $29,075.00
| Facility | | $875.00 | $26,502.00 | $29,075.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,858.11 / $2,880.07 / $9,359.94
| Professional | | $1,858.11 | $2,880.07 | $9,359.94 |
- 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
- $2,600.00 / $7,055.00 / $14,572.00
| Facility | | $2,600.00 | $7,055.00 | $14,572.00 |