- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,207.00 / $2,800.00 / $5,580.00
| Facility | | $1,207.00 | $2,800.00 | $5,580.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,138.27 / $11,505.18 / $25,094.26
| Facility | | $3,138.27 | $11,505.18 | $25,094.26 |
- 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
- $983.72 / $1,655.22 / $4,184.52
| Professional | | $983.72 | $1,655.22 | $4,184.52 |
- 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
- $1,282.00 / $3,751.00 / $6,625.00
| Facility | | $1,282.00 | $3,751.00 | $6,625.00 |