- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,000.00 / $4,897.79 / $11,481.54
| Facility | | $1,000.00 | $4,897.79 | $11,481.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $223.87 / $263.03 / $407.38
| Professional | | $223.87 | $263.03 | $407.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,089.30 / $4,365.16 / $9,332.54
| Facility | | $2,089.30 | $4,365.16 | $9,332.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $239.88 / $323.59 / $575.44
| Professional | | $239.88 | $323.59 | $575.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $169.82 / $213.80 / $53,703.18
| Facility | | $169.82 | $213.80 | $53,703.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $125.89 / $309.03 / $407.38
| Professional | | $125.89 | $309.03 | $407.38 |