- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,393.00 / $5,549.00 / $10,506.16
| Facility | | $4,393.00 | $5,549.00 | $10,506.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $163.09 / $235.21 / $349.74
| Professional | | $163.09 | $235.21 | $349.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $177.83 / $444.68 / $5,023.00
| Facility | | $177.83 | $444.68 | $5,023.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $214.00 / $526.84 / $1,552.02
| Facility | | $214.00 | $526.84 | $1,552.02 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,044.00 / $5,023.00 / $7,305.00
| Facility | | $3,044.00 | $5,023.00 | $7,305.00 |