- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,017.00 / $3,221.00 / $10,073.00
| Facility | | $1,017.00 | $3,221.00 | $10,073.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,070.62 / $9,928.21 / $18,698.21
| Facility | | $7,070.62 | $9,928.21 | $18,698.21 |
- 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
- $881.30 / $1,301.85 / $3,728.82
| Professional | | $881.30 | $1,301.85 | $3,728.82 |
- 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 |