- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $478.63 / $3,235.94 / $10,232.93
| Facility | | $478.63 | $3,235.94 | $10,232.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,000.00 / $2,187.76 / $8,317.64
| Facility | | $1,000.00 | $2,187.76 | $8,317.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $16,595.87 / $16,595.87 / $16,595.87
| Facility | | $16,595.87 | $16,595.87 | $16,595.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $295.12 / $446.68 / $2,041.74
| Professional | | $295.12 | $446.68 | $2,041.74 |
- 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
- $158.49 / $1,995.26 / $19,498.45
| Facility | | $158.49 | $1,995.26 | $19,498.45 |