- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,000.00 / $7,838.38 / $8,942.39
| Facility | | $1,000.00 | $7,838.38 | $8,942.39 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $373.16 / $379.94 / $395.23
| Professional | | $373.16 | $379.94 | $395.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $60.00 / $85.00 / $580.61
| Professional | | $60.00 | $85.00 | $580.61 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $28,768.00 / $46,929.00 / $46,929.00
| Facility | | $28,768.00 | $46,929.00 | $46,929.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $514.79 / $643.49 / $924.30
| Professional | | $514.79 | $643.49 | $924.30 |