- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,017.00 / $2,784.00 / $7,123.00
| Facility | | $1,017.00 | $2,784.00 | $7,123.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,355.56 / $13,594.80 / $27,223.58
| Facility | | $6,355.56 | $13,594.80 | $27,223.58 |
- 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
- $1,178.86 / $1,720.02 / $5,237.38
| Professional | | $1,178.86 | $1,720.02 | $5,237.38 |
- 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 |