- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,000.00 / $5,000.27 / $7,838.38
| Facility | | $1,000.00 | $5,000.27 | $7,838.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $964.00 / $964.00 / $964.00
| Professional | | $964.00 | $964.00 | $964.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $569.63 / $2,088.69 / $3,403.51
| Facility | | $569.63 | $2,088.69 | $3,403.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $60.00 / $60.00 / $386.77
| Professional | | $60.00 | $60.00 | $386.77 |
- 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 |