- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,005.26 / $2,265.00 / $5,405.00
| Facility | | $1,005.26 | $2,265.00 | $5,405.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,538.45 / $12,007.50 / $23,506.50
| Facility | | $8,538.45 | $12,007.50 | $23,506.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $709.00 / $6,831.39 / $7,626.43
| Facility | | $709.00 | $6,831.39 | $7,626.43 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,117.26 / $1,660.62 / $5,279.03
| Professional | | $1,117.26 | $1,660.62 | $5,279.03 |
- 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
- $2,132.00 / $5,951.00 / $12,241.00
| Facility | | $2,132.00 | $5,951.00 | $12,241.00 |