- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,060.75 / $3,861.00 / $19,646.41
| Facility | | $1,060.75 | $3,861.00 | $19,646.41 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,681.94 / $13,783.13 / $20,186.31
| Facility | | $6,681.94 | $13,783.13 | $20,186.31 |
- 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
- $869.85 / $1,394.03 / $3,859.50
| Professional | | $869.85 | $1,394.03 | $3,859.50 |
- 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
- $1,602.00 / $7,500.00 / $14,716.00
| Facility | | $1,602.00 | $7,500.00 | $14,716.00 |