- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,087.35 / $3,847.00 / $10,073.00
| Facility | | $1,087.35 | $3,847.00 | $10,073.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,745.41 / $10,885.18 / $21,862.58
| Facility | | $4,745.41 | $10,885.18 | $21,862.58 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,855.00 / $6,643.00 / $15,148.00
| Facility | | $1,855.00 | $6,643.00 | $15,148.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $521.75 / $853.78 / $4,214.17
| Professional | | $521.75 | $853.78 | $4,214.17 |
- 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
- $2,276.00 / $8,141.00 / $21,651.00
| Facility | | $2,276.00 | $8,141.00 | $21,651.00 |