- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,000.00 / $1,071.52 / $3,235.94
| Facility | | $1,000.00 | $1,071.52 | $3,235.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $436.52 / $1,071.52 / $1,905.46
| Professional | | $436.52 | $1,071.52 | $1,905.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $64.57 / $85.11 / $9,772.37
| Facility | | $64.57 | $85.11 | $9,772.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $51.29 / $67.61 / $109.65
| Professional | | $51.29 | $67.61 | $109.65 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $64.57 / $64.57 / $64.57
| Facility | | $64.57 | $64.57 | $64.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1.82 / $1.82 / $645.65
| Professional | | $1.82 | $1.82 | $645.65 |