- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,000.00 / $7,838.38 / $14,860.56
| Facility | | $1,000.00 | $7,838.38 | $14,860.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $310.68 / $316.31 / $329.06
| Professional | | $310.68 | $316.31 | $329.06 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $60.00 / $85.00 / $484.48
| Professional | | $60.00 | $85.00 | $484.48 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,824.00 / $2,516.00 / $2,655.00
| Facility | | $1,824.00 | $2,516.00 | $2,655.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $428.56 / $535.70 / $769.45
| Professional | | $428.56 | $535.70 | $769.45 |