- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $676.08 / $1,148.15 / $15,135.61
| Facility | | $676.08 | $1,148.15 | $15,135.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $257.04 / $426.58 / $724.44
| Professional | | $257.04 | $426.58 | $724.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $316.23 / $316.23 / $316.23
| Facility | | $316.23 | $316.23 | $316.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $245.47 / $380.19 / $724.44
| Professional | | $245.47 | $380.19 | $724.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,000.00 / $1,023.29 / $1,479.11
| Facility | | $1,000.00 | $1,023.29 | $1,479.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $229.09 / $338.84 / $524.81
| Professional | | $229.09 | $338.84 | $524.81 |