- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,017.00 / $2,784.00 / $6,661.00
| Facility | | $1,017.00 | $2,784.00 | $6,661.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,905.16 / $14,770.40 / $29,577.72
| Facility | | $6,905.16 | $14,770.40 | $29,577.72 |
- 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
- $1,280.25 / $1,863.30 / $5,961.77
| Professional | | $1,280.25 | $1,863.30 | $5,961.77 |
- 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
- $2,537.00 / $6,885.00 / $14,716.00
| Facility | | $2,537.00 | $6,885.00 | $14,716.00 |