- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,017.00 / $3,636.00 / $5,565.33
| Facility | | $1,017.00 | $3,636.00 | $5,565.33 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14,571.52 / $31,169.04 / $62,416.00
| Facility | | $14,571.52 | $31,169.04 | $62,416.00 |
- 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
- $2,655.51 / $4,075.03 / $9,376.61
| Professional | | $2,655.51 | $4,075.03 | $9,376.61 |
- 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 / $2,690.00 / $6,362.00
| Facility | | $800.00 | $2,690.00 | $6,362.00 |