- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,148.15 / $4,073.80 / $10,000.00
| Facility | | $1,148.15 | $4,073.80 | $10,000.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,120.11 / $24,547.09 / $46,773.51
| Facility | | $9,120.11 | $24,547.09 | $46,773.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,949.84 / $3,235.94 / $10,471.29
| Professional | | $1,949.84 | $3,235.94 | $10,471.29 |
- 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
- $575.44 / $2,884.03 / $7,413.10
| Facility | | $575.44 | $2,884.03 | $7,413.10 |