- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,207.00 / $2,824.00 / $5,580.00
| Facility | | $1,207.00 | $2,824.00 | $5,580.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,679.45 / $14,890.13 / $26,149.40
| Facility | | $8,679.45 | $14,890.13 | $26,149.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $400.00 / $785.00 / $1,429.01
| Facility | | $400.00 | $785.00 | $1,429.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,381.42 / $2,115.12 / $5,550.04
| Professional | | $1,381.42 | $2,115.12 | $5,550.04 |
- 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
- $2,276.00 / $8,100.00 / $21,651.00
| Facility | | $2,276.00 | $8,100.00 | $21,651.00 |