- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,143.64 / $3,357.54 / $11,950.45
| Facility | | $1,143.64 | $3,357.54 | $11,950.45 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,495.60 / $17,704.66 / $26,742.21
| Facility | | $11,495.60 | $17,704.66 | $26,742.21 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $709.00 / $17,042.93 / $19,026.39
| Facility | | $709.00 | $17,042.93 | $19,026.39 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,274.07 / $1,865.88 / $4,808.17
| Professional | | $1,274.07 | $1,865.88 | $4,808.17 |
- 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 |