- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $436.52 / $1,148.15 / $18,620.87
| Facility | | $436.52 | $1,148.15 | $18,620.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $436.52 / $691.83 / $1,174.90
| Professional | | $436.52 | $691.83 | $1,174.90 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $446.68 / $549.54 / $794.33
| Professional | | $446.68 | $549.54 | $794.33 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,445.44 / $5,128.61 / $12,589.25
| Facility | | $1,445.44 | $5,128.61 | $12,589.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,000.00 / $1,000.00 / $1,000.00
| Facility | | $1,000.00 | $1,000.00 | $1,000.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $407.38 / $501.19 / $776.25
| Professional | | $407.38 | $501.19 | $776.25 |