- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,150.00 / $4,131.00 / $40,324.00
| Facility | | $2,150.00 | $4,131.00 | $40,324.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,671.00 / $4,589.00 / $6,006.00
| Facility | | $3,671.00 | $4,589.00 | $6,006.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,055.71 / $2,055.71 / $2,055.71
| Facility | | $2,055.71 | $2,055.71 | $2,055.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $11.03 / $750.06 / $2,840.08
| Professional | | $11.03 | $750.06 | $2,840.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,184.67 / $4,022.08 / $4,022.08
| Facility | | $2,184.67 | $4,022.08 | $4,022.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,642.00 / $3,000.00 / $9,042.00
| Facility | | $1,642.00 | $3,000.00 | $9,042.00 |