- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,129.00 / $2,336.40 / $8,187.41
| Facility | | $1,129.00 | $2,336.40 | $8,187.41 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,815.40 / $16,717.43 / $33,476.67
| Facility | | $7,815.40 | $16,717.43 | $33,476.67 |
- 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
- $1,322.08 / $2,119.32 / $5,579.66
| Professional | | $1,322.08 | $2,119.32 | $5,579.66 |
- 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
- $578.00 / $2,873.00 / $7,384.00
| Facility | | $578.00 | $2,873.00 | $7,384.00 |