- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,072.76 / $1,910.30 / $5,430.00
| Facility | | $1,072.76 | $1,910.30 | $5,430.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,394.27 / $11,758.64 / $23,546.67
| Facility | | $5,394.27 | $11,758.64 | $23,546.67 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $400.00 / $785.00 / $1,141.67
| Facility | | $400.00 | $785.00 | $1,141.67 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,071.09 / $1,665.91 / $3,590.69
| Professional | | $1,071.09 | $1,665.91 | $3,590.69 |
- 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 |