- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,026.14 / $2,933.00 / $6,545.75
| Facility | | $1,026.14 | $2,933.00 | $6,545.75 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,314.54 / $17,704.66 / $24,947.49
| Facility | | $10,314.54 | $17,704.66 | $24,947.49 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $875.00 / $14,975.00 / $19,446.00
| Facility | | $875.00 | $14,975.00 | $19,446.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,181.13 / $1,727.88 / $4,753.84
| Professional | | $1,181.13 | $1,727.88 | $4,753.84 |
- 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 |