- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,000.00 / $2,173.00 / $4,841.00
| Facility | | $1,000.00 | $2,173.00 | $4,841.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $532.17 / $3,959.00 / $10,300.00
| Professional | | $532.17 | $3,959.00 | $10,300.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,779.00 / $3,647.00 / $4,098.00
| Facility | | $2,779.00 | $3,647.00 | $4,098.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $345.41 / $345.41 / $345.41
| Facility | | $345.41 | $345.41 | $345.41 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $200.00 / $1,427.00 / $1,998.00
| Facility | | $200.00 | $1,427.00 | $1,998.00 |