- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,017.00 / $2,265.00 / $8,102.85
| Facility | | $1,017.00 | $2,265.00 | $8,102.85 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,563.78 / $13,031.84 / $26,538.30
| Facility | | $8,563.78 | $13,031.84 | $26,538.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,855.00 / $7,626.43 / $17,537.00
| Facility | | $1,855.00 | $7,626.43 | $17,537.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,303.78 / $1,902.97 / $9,354.99
| Professional | | $1,303.78 | $1,902.97 | $9,354.99 |
- 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
- $2,575.00 / $6,920.00 / $14,716.00
| Facility | | $2,575.00 | $6,920.00 | $14,716.00 |