- 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
- $385.23 / $406.27 / $422.62
| Professional | | $385.23 | $406.27 | $422.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $60.00 / $85.00 / $629.41
| Professional | | $60.00 | $85.00 | $629.41 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,602.00 / $9,127.00 / $13,891.00
| Facility | | $6,602.00 | $9,127.00 | $13,891.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $516.55 / $633.96 / $927.46
| Professional | | $516.55 | $633.96 | $927.46 |