- 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
- $175.18 / $302.04 / $664.73
| Professional | | $175.18 | $302.04 | $664.73 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $272.37 / $429.48 / $5,847.00
| Facility | | $272.37 | $429.48 | $5,847.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $284.44 / $426.36 / $557.41
| Facility | | $284.44 | $426.36 | $557.41 |
- 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 |