- 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
- $229.09 / $257.04 / $371.54
| Professional | | $229.09 | $257.04 | $371.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $575.44 / $1,318.26 / $4,466.84
| Facility | | $575.44 | $1,318.26 | $4,466.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $213.80 / $213.80 / $288.40
| Professional | | $213.80 | $213.80 | $288.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $60.26 / $158.49 / $234.42
| Professional | | $60.26 | $158.49 | $234.42 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $223.87 / $316.23 / $616.60
| Facility | | $223.87 | $316.23 | $616.60 |