- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,277.00 / $5,549.00 / $11,100.08
| Facility | | $4,277.00 | $5,549.00 | $11,100.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $142.40 / $224.28 / $582.35
| Professional | | $142.40 | $224.28 | $582.35 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $192.31 / $353.41 / $5,847.00
| Facility | | $192.31 | $353.41 | $5,847.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $233.31 / $332.60 / $453.49
| Facility | | $233.31 | $332.60 | $453.49 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,126.00 / $5,847.00 / $7,305.00
| Facility | | $2,126.00 | $5,847.00 | $7,305.00 |