- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,142.33 / $2,013.70 / $7,407.00
| Facility | | $1,142.33 | $2,013.70 | $7,407.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,808.03 / $14,562.64 / $29,161.68
| Facility | | $6,808.03 | $14,562.64 | $29,161.68 |
- 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
- $1,182.68 / $1,841.50 / $5,630.73
| Professional | | $1,182.68 | $1,841.50 | $5,630.73 |
- 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 |