- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,000.00 / $7,838.38 / $8,226.04
| Facility | | $1,000.00 | $7,838.38 | $8,226.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,016.27 / $2,144.38 / $3,458.63
| Professional | | $2,016.27 | $2,144.38 | $3,458.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $50.00 / $60.00 / $1,500.00
| Professional | | $50.00 | $60.00 | $1,500.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,124.04 / $2,685.83 / $3,458.63
| Facility | | $1,124.04 | $2,685.83 | $3,458.63 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,085.00 / $5,089.00 / $17,636.00
| Facility | | $3,085.00 | $5,089.00 | $17,636.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,615.81 / $3,317.60 / $4,593.60
| Professional | | $2,615.81 | $3,317.60 | $4,593.60 |