- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,003.87 / $2,368.00 / $11,170.16
| Facility | | $1,003.87 | $2,368.00 | $11,170.16 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,538.45 / $11,990.89 / $23,473.97
| Facility | | $8,538.45 | $11,990.89 | $23,473.97 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $709.00 / $8,799.43 / $9,823.51
| Facility | | $709.00 | $8,799.43 | $9,823.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,134.10 / $1,646.22 / $4,473.14
| Professional | | $1,134.10 | $1,646.22 | $4,473.14 |
- 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
- $2,600.00 / $7,253.00 / $14,468.00
| Facility | | $2,600.00 | $7,253.00 | $14,468.00 |