- 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
- $2,187.76 / $4,570.88 / $9,549.93
| Professional | | $2,187.76 | $4,570.88 | $9,549.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $676.08 / $1,659.59 / $2,754.23
| Facility | | $676.08 | $1,659.59 | $2,754.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.36 / $60.26 / $316.23
| Professional | | $32.36 | $60.26 | $316.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,202.26 / $1,202.26 / $1,202.26
| Facility | | $1,202.26 | $1,202.26 | $1,202.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $416.87 / $2,344.23 / $3,090.30
| Facility | | $416.87 | $2,344.23 | $3,090.30 |