- 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
- $411.81 / $430.03 / $447.34
| Professional | | $411.81 | $430.03 | $447.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $60.00 / $85.00 / $664.40
| Professional | | $60.00 | $85.00 | $664.40 |
- 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
- $552.20 / $677.71 / $991.45
| Professional | | $552.20 | $677.71 | $991.45 |