- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,036.96 / $3,270.00 / $10,000.00
| Facility | | $1,036.96 | $3,270.00 | $10,000.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,681.94 / $14,651.36 / $24,304.96
| Facility | | $6,681.94 | $14,651.36 | $24,304.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $875.00 / $875.00 / $908.00
| Facility | | $875.00 | $875.00 | $908.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,122.97 / $1,799.15 / $4,670.33
| Professional | | $1,122.97 | $1,799.15 | $4,670.33 |
- 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 |