- 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
- $660.69 / $660.69 / $1,380.38
| Professional | | $660.69 | $660.69 | $1,380.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $44.67 / $60.26 / $85.11
| Professional | | $44.67 | $60.26 | $85.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $562.34 / $660.69 / $1,380.38
| Facility | | $562.34 | $660.69 | $1,380.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $562.34 / $4,265.80 / $6,760.83
| Facility | | $562.34 | $4,265.80 | $6,760.83 |