- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,000.00 / $7,762.47 / $7,762.47
| Facility | | $1,000.00 | $7,762.47 | $7,762.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $173.78 / $363.08 / $707.95
| Professional | | $173.78 | $363.08 | $707.95 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $912.01 / $1,995.26 / $3,235.94
| Facility | | $912.01 | $1,995.26 | $3,235.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $33.11 / $60.26 / $85.11
| Professional | | $33.11 | $60.26 | $85.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $501.19 / $501.19 / $501.19
| Facility | | $501.19 | $501.19 | $501.19 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $416.87 / $2,344.23 / $4,073.80
| Facility | | $416.87 | $2,344.23 | $4,073.80 |