- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,632.40 / $5,045.00 / $6,915.00
| Facility | | $2,632.40 | $5,045.00 | $6,915.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,361.69 / $8,967.21 / $21,657.35
| Facility | | $2,361.69 | $8,967.21 | $21,657.35 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,958.48 / $3,958.48 / $3,958.48
| Facility | | $3,958.48 | $3,958.48 | $3,958.48 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $500.00 / $2,946.70 / $57,200.00
| Facility | | $500.00 | $2,946.70 | $57,200.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,006.84 / $4,183.42 / $7,561.44
| Professional | | $3,006.84 | $4,183.42 | $7,561.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $625.00 / $3,587.00 / $9,079.00
| Facility | | $625.00 | $3,587.00 | $9,079.00 |