- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,000.00 / $3,684.00 / $18,600.00
| Facility | | $1,000.00 | $3,684.00 | $18,600.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $235.50 / $235.51 / $238.28
| Professional | | $235.50 | $235.51 | $238.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $283.00 / $283.00 / $283.00
| Professional | | $283.00 | $283.00 | $283.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $217.35 / $250.19 / $372.60
| Facility | | $217.35 | $250.19 | $372.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $222.88 / $428.70 / $1,813.11
| Professional | | $222.88 | $428.70 | $1,813.11 |