- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,023.67 / $2,933.00 / $10,694.00
| Facility | | $1,023.67 | $2,933.00 | $10,694.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,247.33 / $13,363.28 / $26,759.96
| Facility | | $6,247.33 | $13,363.28 | $26,759.96 |
- 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
- $1,163.21 / $1,713.78 / $4,786.43
| Professional | | $1,163.21 | $1,713.78 | $4,786.43 |
- 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
- $2,100.00 / $5,820.00 / $12,241.00
| Facility | | $2,100.00 | $5,820.00 | $12,241.00 |