- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,017.00 / $3,009.78 / $7,123.00
| Facility | | $1,017.00 | $3,009.78 | $7,123.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,076.56 / $21,554.16 / $43,162.20
| Facility | | $10,076.56 | $21,554.16 | $43,162.20 |
- 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
- $1,840.33 / $2,700.40 / $7,260.32
| Professional | | $1,840.33 | $2,700.40 | $7,260.32 |
- 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 |