- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,207.00 / $3,148.00 / $8,783.00
| Facility | | $1,207.00 | $3,148.00 | $8,783.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,608.55 / $10,427.26 / $33,568.00
| Facility | | $3,608.55 | $10,427.26 | $33,568.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,140.00 / $14,000.00 / $19,116.00
| Facility | | $7,140.00 | $14,000.00 | $19,116.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,468.56 / $2,086.59 / $6,228.07
| Professional | | $1,468.56 | $2,086.59 | $6,228.07 |
- 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
- $1,602.00 / $7,500.00 / $14,716.00
| Facility | | $1,602.00 | $7,500.00 | $14,716.00 |