- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,277.00 / $6,066.00 / $11,100.08
| Facility | | $4,277.00 | $6,066.00 | $11,100.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $295.27 / $491.80 / $980.68
| Professional | | $295.27 | $491.80 | $980.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $431.05 / $728.47 / $4,663.00
| Facility | | $431.05 | $728.47 | $4,663.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $547.26 / $702.05 / $904.61
| Facility | | $547.26 | $702.05 | $904.61 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,126.00 / $5,847.00 / $7,856.00
| Facility | | $2,126.00 | $5,847.00 | $7,856.00 |