- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,022.80 / $3,176.00 / $13,495.66
| Facility | | $1,022.80 | $3,176.00 | $13,495.66 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,281.04 / $17,704.66 / $24,947.49
| Facility | | $10,281.04 | $17,704.66 | $24,947.49 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $875.00 / $17,156.53 / $19,153.21
| Facility | | $875.00 | $17,156.53 | $19,153.21 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,168.50 / $1,670.94 / $5,041.32
| Professional | | $1,168.50 | $1,670.94 | $5,041.32 |
- 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
- $2,575.00 / $6,920.00 / $14,716.00
| Facility | | $2,575.00 | $6,920.00 | $14,716.00 |