- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,000.00 / $2,095.00 / $7,838.38
| Facility | | $1,000.00 | $2,095.00 | $7,838.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,201.78 / $1,201.78 / $1,201.78
| Professional | | $1,201.78 | $1,201.78 | $1,201.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $45.00 / $60.00 / $85.00
| Professional | | $45.00 | $60.00 | $85.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,021.51 / $1,021.51 / $1,021.51
| Facility | | $1,021.51 | $1,021.51 | $1,021.51 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $230.00 / $1,158.00 / $1,327.00
| Facility | | $230.00 | $1,158.00 | $1,327.00 |