- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,070.76 / $2,784.00 / $7,123.00
| Facility | | $1,070.76 | $2,784.00 | $7,123.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,831.33 / $16,751.52 / $33,544.91
| Facility | | $7,831.33 | $16,751.52 | $33,544.91 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $875.00 / $875.00 / $908.00
| Facility | | $875.00 | $875.00 | $908.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,099.85 / $1,708.40 / $4,540.14
| Professional | | $1,099.85 | $1,708.40 | $4,540.14 |
- 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
- $578.00 / $2,873.00 / $7,384.00
| Facility | | $578.00 | $2,873.00 | $7,384.00 |