- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,149.13 / $3,107.00 / $10,750.00
| Facility | | $1,149.13 | $3,107.00 | $10,750.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,091.59 / $12,388.86 / $28,820.20
| Facility | | $7,091.59 | $12,388.86 | $28,820.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,383.00 / $1,383.00 / $1,434.00
| Facility | | $1,383.00 | $1,383.00 | $1,434.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,330.21 / $2,031.66 / $5,706.42
| Professional | | $1,330.21 | $2,031.66 | $5,706.42 |
- 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
- $1,300.00 / $5,978.00 / $12,241.00
| Facility | | $1,300.00 | $5,978.00 | $12,241.00 |