- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,000.00 / $7,838.38 / $7,838.38
| Facility | | $1,000.00 | $7,838.38 | $7,838.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,309.23 / $1,348.73 / $1,361.95
| Professional | | $1,309.23 | $1,348.73 | $1,361.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $60.00 / $60.00 / $1,900.73
| Professional | | $60.00 | $60.00 | $1,900.73 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,085.00 / $4,262.00 / $17,636.00
| Facility | | $3,085.00 | $4,262.00 | $17,636.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,820.28 / $2,233.98 / $3,263.48
| Professional | | $1,820.28 | $2,233.98 | $3,263.48 |