- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,017.00 / $3,270.00 / $6,661.00
| Facility | | $1,017.00 | $3,270.00 | $6,661.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,622.72 / $24,861.44 / $49,785.03
| Facility | | $11,622.72 | $24,861.44 | $49,785.03 |
- 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
- $2,056.26 / $3,074.63 / $7,727.20
| Professional | | $2,056.26 | $3,074.63 | $7,727.20 |
- 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
- $2,537.00 / $6,885.00 / $14,716.00
| Facility | | $2,537.00 | $6,885.00 | $14,716.00 |