- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,272.00 / $3,407.77 / $9,691.00
| Facility | | $1,272.00 | $3,407.77 | $9,691.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,830.79 / $13,112.07 / $28,599.09
| Facility | | $6,830.79 | $13,112.07 | $28,599.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,125.46 / $1,882.74 / $6,102.75
| Professional | | $1,125.46 | $1,882.74 | $6,102.75 |
- 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
- $2,050.00 / $5,978.00 / $12,241.00
| Facility | | $2,050.00 | $5,978.00 | $12,241.00 |