- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,159.00 / $4,135.71 / $7,407.00
| Facility | | $1,159.00 | $4,135.71 | $7,407.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $19,060.41 / $40,770.96 / $81,643.84
| Facility | | $19,060.41 | $40,770.96 | $81,643.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,676.05 / $4,014.07 / $12,209.62
| Professional | | $2,676.05 | $4,014.07 | $12,209.62 |
- 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 |