- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,137.14 / $2,140.06 / $7,407.00
| Facility | | $1,137.14 | $2,140.06 | $7,407.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,316.86 / $17,790.08 / $35,624.62
| Facility | | $8,316.86 | $17,790.08 | $35,624.62 |
- 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
- $1,202.84 / $1,888.03 / $5,597.77
| Professional | | $1,202.84 | $1,888.03 | $5,597.77 |
- 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
- $1,300.00 / $5,978.00 / $12,241.00
| Facility | | $1,300.00 | $5,978.00 | $12,241.00 |