- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $308.63 / $4,500.35 / $8,122.68
| Facility | | $308.63 | $4,500.35 | $8,122.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $205.63 / $308.64 / $424.19
| Professional | | $205.63 | $308.64 | $424.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $228.18 / $397.23 / $607.47
| Professional | | $228.18 | $397.23 | $607.47 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,387.00 / $4,237.16 / $10,106.81
| Facility | | $3,387.00 | $4,237.16 | $10,106.81 |
- 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
- $356.97 / $581.59 / $818.63
| Professional | | $356.97 | $581.59 | $818.63 |