- 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
- $333.42 / $347.44 / $361.43
| Professional | | $333.42 | $347.44 | $361.43 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $60.00 / $85.00 / $541.30
| Professional | | $60.00 | $85.00 | $541.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,602.00 / $9,127.00 / $10,150.00
| Facility | | $6,602.00 | $9,127.00 | $10,150.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $447.04 / $548.64 / $731.52
| Professional | | $447.04 | $548.64 | $731.52 |