- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,000.00 / $5,000.27 / $7,838.38
| Facility | | $1,000.00 | $5,000.27 | $7,838.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $391.04 / $406.79 / $409.53
| Professional | | $391.04 | $406.79 | $409.53 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $60.00 / $85.00 / $532.94
| Professional | | $60.00 | $85.00 | $532.94 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,085.00 / $3,085.00 / $4,616.00
| Facility | | $3,085.00 | $3,085.00 | $4,616.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $514.90 / $693.37 / $1,014.37
| Professional | | $514.90 | $693.37 | $1,014.37 |