- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $276.35 / $419.81 / $6,404.52
| Facility | | $276.35 | $419.81 | $6,404.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $257.42 / $358.88 / $420.09
| Professional | | $257.42 | $358.88 | $420.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,732.57 / $1,732.57 / $1,732.57
| Facility | | $1,732.57 | $1,732.57 | $1,732.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $285.55 / $405.34 / $757.89
| Professional | | $285.55 | $405.34 | $757.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,990.17 / $3,990.17 / $3,990.17
| Facility | | $3,990.17 | $3,990.17 | $3,990.17 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,485.00 / $1,485.00 / $1,485.00
| Facility | | $1,485.00 | $1,485.00 | $1,485.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $359.51 / $449.98 / $972.03
| Professional | | $359.51 | $449.98 | $972.03 |