- 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
- $12,127.24 / $25,940.64 / $51,946.13
| Facility | | $12,127.24 | $25,940.64 | $51,946.13 |
- 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
- $1,685.78 / $3,152.13 / $7,968.35
| Professional | | $1,685.78 | $3,152.13 | $7,968.35 |
- 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 |