- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,017.00 / $3,148.00 / $8,783.00
| Facility | | $1,017.00 | $3,148.00 | $8,783.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,009.16 / $9,576.35 / $19,192.88
| Facility | | $5,009.16 | $9,576.35 | $19,192.88 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,855.00 / $1,855.00 / $1,923.00
| Facility | | $1,855.00 | $1,855.00 | $1,923.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $616.91 / $963.68 / $2,004.26
| Professional | | $616.91 | $963.68 | $2,004.26 |
- 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
- $2,600.00 / $7,474.00 / $14,468.00
| Facility | | $2,600.00 | $7,474.00 | $14,468.00 |