- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,272.00 / $3,270.00 / $8,806.00
| Facility | | $1,272.00 | $3,270.00 | $8,806.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,535.43 / $13,067.99 / $28,502.94
| Facility | | $5,535.43 | $13,067.99 | $28,502.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,121.60 / $1,876.93 / $5,140.77
| Professional | | $1,121.60 | $1,876.93 | $5,140.77 |
- 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
- $2,255.00 / $5,978.00 / $11,479.00
| Facility | | $2,255.00 | $5,978.00 | $11,479.00 |