- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,000.00 / $7,838.38 / $8,763.29
| Facility | | $1,000.00 | $7,838.38 | $8,763.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $438.74 / $461.50 / $480.08
| Professional | | $438.74 | $461.50 | $480.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $60.00 / $85.00 / $711.92
| Professional | | $60.00 | $85.00 | $711.92 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,609.00 / $21,608.00 / $23,542.00
| Facility | | $10,609.00 | $21,608.00 | $23,542.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $588.28 / $721.98 / $1,056.24
| Professional | | $588.28 | $721.98 | $1,056.24 |