- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,017.00 / $3,636.00 / $5,642.86
| Facility | | $1,017.00 | $3,636.00 | $5,642.86 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14,964.26 / $32,009.12 / $64,098.26
| Facility | | $14,964.26 | $32,009.12 | $64,098.26 |
- 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
- $2,690.63 / $4,131.80 / $11,949.60
| Professional | | $2,690.63 | $4,131.80 | $11,949.60 |
- 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
- $800.00 / $2,800.00 / $7,384.00
| Facility | | $800.00 | $2,800.00 | $7,384.00 |