- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,105.00 / $3,221.00 / $10,000.00
| Facility | | $1,105.00 | $3,221.00 | $10,000.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,462.98 / $22,380.72 / $44,817.39
| Facility | | $10,462.98 | $22,380.72 | $44,817.39 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $875.00 / $908.00 / $16,000.00
| Facility | | $875.00 | $908.00 | $16,000.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,919.48 / $2,833.52 / $9,404.46
| Professional | | $1,919.48 | $2,833.52 | $9,404.46 |
- 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
- $2,421.00 / $7,842.00 / $21,651.00
| Facility | | $2,421.00 | $7,842.00 | $21,651.00 |