- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,000.00 / $2,145.78 / $7,838.38
| Facility | | $1,000.00 | $2,145.78 | $7,838.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $80.00 / $930.80 / $1,861.60
| Professional | | $80.00 | $930.80 | $1,861.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $147.69 / $514.57 / $882.45
| Facility | | $147.69 | $514.57 | $882.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $60.00 / $60.00 / $1,500.00
| Professional | | $60.00 | $60.00 | $1,500.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $230.00 / $1,158.00 / $1,401.00
| Facility | | $230.00 | $1,158.00 | $1,401.00 |