- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,590.48 / $4,385.03 / $5,088.14
| Facility | | $2,590.48 | $4,385.03 | $5,088.14 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13,547.62 / $28,978.88 / $58,030.20
| Facility | | $13,547.62 | $28,978.88 | $58,030.20 |
- 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
- $2,608.56 / $4,399.54 / $7,396.68
| Professional | | $2,608.56 | $4,399.54 | $7,396.68 |
- 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 |