- 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
- $204.16 / $213.90 / $222.51
| Professional | | $204.16 | $213.90 | $222.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $60.00 / $85.00 / $333.50
| Professional | | $60.00 | $85.00 | $333.50 |
- 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
- $279.89 / $335.88 / $491.37
| Professional | | $279.89 | $335.88 | $491.37 |