- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,023.29 / $3,715.35 / $10,000.00
| Facility | | $1,023.29 | $3,715.35 | $10,000.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,128.61 / $6,165.95 / $17,782.79
| Facility | | $5,128.61 | $6,165.95 | $17,782.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $676.08 / $1,258.93 / $3,630.78
| Professional | | $676.08 | $1,258.93 | $3,630.78 |
- 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
- $2,041.74 / $5,370.32 / $12,302.69
| Facility | | $2,041.74 | $5,370.32 | $12,302.69 |