- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,159.00 / $4,200.00 / $7,754.93
| Facility | | $1,159.00 | $4,200.00 | $7,754.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $21,080.39 / $45,091.76 / $90,296.24
| Facility | | $21,080.39 | $45,091.76 | $90,296.24 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,358.02 / $5,353.82 / $15,449.55
| Professional | | $3,358.02 | $5,353.82 | $15,449.55 |
- 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
- $578.00 / $2,873.00 / $7,384.00
| Facility | | $578.00 | $2,873.00 | $7,384.00 |