- 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
- $166.56 / $292.12 / $538.41
| Professional | | $166.56 | $292.12 | $538.41 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $261.12 / $412.04 / $5,847.00
| Facility | | $261.12 | $412.04 | $5,847.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $270.52 / $406.70 / $530.66
| Facility | | $270.52 | $406.70 | $530.66 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,126.00 / $5,854.53 / $7,305.00
| Facility | | $2,126.00 | $5,854.53 | $7,305.00 |