- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $33,533.00 / $33,533.00 / $33,533.00
| Facility | | $33,533.00 | $33,533.00 | $33,533.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $33,533.00 / $33,533.00 / $33,533.00
| Professional | | $33,533.00 | $33,533.00 | $33,533.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,711.00 / $8,432.00 / $8,472.00
| Facility | | $6,711.00 | $8,432.00 | $8,472.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $263.52 / $429.55 / $1,322.57
| Facility | | $263.52 | $429.55 | $1,322.57 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $292.26 / $345.07 / $706.10
| Facility | | $292.26 | $345.07 | $706.10 |