- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,053.45 / $1,873.96 / $5,430.00
| Facility | | $1,053.45 | $1,873.96 | $5,430.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,297.13 / $11,546.88 / $23,122.62
| Facility | | $5,297.13 | $11,546.88 | $23,122.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $400.00 / $785.00 / $1,114.58
| Facility | | $400.00 | $785.00 | $1,114.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,073.06 / $1,658.37 / $5,167.51
| Professional | | $1,073.06 | $1,658.37 | $5,167.51 |
- 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
- $557.00 / $2,873.00 / $6,625.00
| Facility | | $557.00 | $2,873.00 | $6,625.00 |