- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,272.00 / $5,389.00 / $29,038.34
| Facility | | $1,272.00 | $5,389.00 | $29,038.34 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,655.28 / $12,832.69 / $35,456.57
| Facility | | $4,655.28 | $12,832.69 | $35,456.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,032.39 / $1,553.51 / $4,539.52
| Professional | | $1,032.39 | $1,553.51 | $4,539.52 |
- 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
- $2,655.00 / $8,879.00 / $35,962.00
| Facility | | $2,655.00 | $8,879.00 | $35,962.00 |