- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,272.00 / $3,647.00 / $10,407.48
| Facility | | $1,272.00 | $3,647.00 | $10,407.48 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,535.43 / $13,030.74 / $28,421.69
| Facility | | $5,535.43 | $13,030.74 | $28,421.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,117.56 / $1,871.88 / $5,423.82
| Professional | | $1,117.56 | $1,871.88 | $5,423.82 |
- 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
- $2,100.00 / $5,405.00 / $11,479.00
| Facility | | $2,100.00 | $5,405.00 | $11,479.00 |