- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,048.00 / $3,148.00 / $10,156.00
| Facility | | $1,048.00 | $3,148.00 | $10,156.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,070.62 / $9,776.60 / $17,644.66
| Facility | | $7,070.62 | $9,776.60 | $17,644.66 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,383.00 / $5,676.58 / $6,337.22
| Facility | | $1,383.00 | $5,676.58 | $6,337.22 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $870.25 / $1,240.10 / $4,270.31
| Professional | | $870.25 | $1,240.10 | $4,270.31 |
- 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
- $2,100.00 / $5,820.00 / $12,241.00
| Facility | | $2,100.00 | $5,820.00 | $12,241.00 |