- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,000.74 / $1,778.30 / $5,430.00
| Facility | | $1,000.74 | $1,778.30 | $5,430.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,032.12 / $10,969.20 / $21,965.82
| Facility | | $5,032.12 | $10,969.20 | $21,965.82 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $400.00 / $785.00 / $1,060.55
| Facility | | $400.00 | $785.00 | $1,060.55 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,023.75 / $1,582.16 / $3,547.36
| Professional | | $1,023.75 | $1,582.16 | $3,547.36 |
- 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 |