- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $922.24 / $5,896.64 / $9,073.78
| Facility | | $922.24 | $5,896.64 | $9,073.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $303.52 / $358.85 / $415.79
| Professional | | $303.52 | $358.85 | $415.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $402.23 / $490.59 / $586.63
| Professional | | $402.23 | $490.59 | $586.63 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,300.63 / $6,300.63 / $6,637.64
| Facility | | $6,300.63 | $6,300.63 | $6,637.64 |
- 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
- $354.53 / $433.52 / $936.32
| Professional | | $354.53 | $433.52 | $936.32 |