- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,272.00 / $2,628.00 / $7,723.00
| Facility | | $1,272.00 | $2,628.00 | $7,723.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,383.17 / $17,938.41 / $35,952.10
| Facility | | $9,383.17 | $17,938.41 | $35,952.10 |
- 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
- $1,362.94 / $2,155.63 / $5,224.70
| Professional | | $1,362.94 | $2,155.63 | $5,224.70 |
- 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
- $1,602.00 / $7,500.00 / $14,716.00
| Facility | | $1,602.00 | $7,500.00 | $14,716.00 |