- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,376.26 / $2,097.50 / $4,803.39
| Facility | | $1,376.26 | $2,097.50 | $4,803.39 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $419.16 / $547.08 / $816.15
| Professional | | $419.16 | $547.08 | $816.15 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $463.50 / $678.27 / $1,133.98
| Professional | | $463.50 | $678.27 | $1,133.98 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,098.60 / $4,814.50 / $5,130.85
| Facility | | $4,098.60 | $4,814.50 | $5,130.85 |
- 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
- $588.47 / $809.15 / $1,591.08
| Professional | | $588.47 | $809.15 | $1,591.08 |