- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,202.26 / $3,715.35 / $10,000.00
| Facility | | $1,202.26 | $3,715.35 | $10,000.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,120.11 / $10,964.78 / $27,542.29
| Facility | | $9,120.11 | $10,964.78 | $27,542.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,120.11 / $10,715.19 / $17,378.01
| Facility | | $9,120.11 | $10,715.19 | $17,378.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,318.26 / $2,137.96 / $6,760.83
| Professional | | $1,318.26 | $2,137.96 | $6,760.83 |
- 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
- $2,570.40 / $6,456.54 / $16,982.44
| Facility | | $2,570.40 | $6,456.54 | $16,982.44 |