- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,122.02 / $3,981.07 / $10,000.00
| Facility | | $1,122.02 | $3,981.07 | $10,000.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,244.36 / $15,488.17 / $21,877.62
| Facility | | $7,244.36 | $15,488.17 | $21,877.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $933.25 / $1,479.11 / $4,073.80
| Professional | | $933.25 | $1,479.11 | $4,073.80 |
- 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
- $2,089.30 / $6,918.31 / $12,882.50
| Facility | | $2,089.30 | $6,918.31 | $12,882.50 |