- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,129.00 / $5,091.00 / $9,691.00
| Facility | | $1,129.00 | $5,091.00 | $9,691.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $26,561.25 / $56,815.52 / $113,773.07
| Facility | | $26,561.25 | $56,815.52 | $113,773.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,332.87 / $7,683.90 / $26,375.46
| Professional | | $4,332.87 | $7,683.90 | $26,375.46 |
- 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 |