- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,159.00 / $5,389.00 / $9,691.00
| Facility | | $1,159.00 | $5,389.00 | $9,691.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $29,465.73 / $63,028.32 / $126,214.21
| Facility | | $29,465.73 | $63,028.32 | $126,214.21 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,426.80 / $7,500.01 / $28,077.58
| Professional | | $4,426.80 | $7,500.01 | $28,077.58 |
- 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 |