- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,003.14 / $1,842.00 / $5,530.58
| Facility | | $1,003.14 | $1,842.00 | $5,530.58 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,978.46 / $12,788.16 / $25,608.29
| Facility | | $5,978.46 | $12,788.16 | $25,608.29 |
- 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
- $1,042.52 / $1,628.75 / $5,304.52
| Professional | | $1,042.52 | $1,628.75 | $5,304.52 |
- 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
- $800.00 / $2,800.00 / $7,384.00
| Facility | | $800.00 | $2,800.00 | $7,384.00 |