- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,000.00 / $3,684.00 / $18,600.00
| Facility | | $1,000.00 | $3,684.00 | $18,600.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $142.86 / $155.74 / $185.31
| Professional | | $142.86 | $155.74 | $185.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $155.74 / $331.39 / $1,470.67
| Facility | | $155.74 | $331.39 | $1,470.67 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $234.55 / $317.73 / $681.54
| Professional | | $234.55 | $317.73 | $681.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $100.00 / $610.00 / $1,883.00
| Facility | | $100.00 | $610.00 | $1,883.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $263.72 / $328.63 / $460.52
| Professional | | $263.72 | $328.63 | $460.52 |