- 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
- $757.24 / $771.65 / $802.73
| Professional | | $757.24 | $771.65 | $802.73 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $60.00 / $85.00 / $579.73
| Professional | | $60.00 | $85.00 | $579.73 |
- 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
- $1,044.56 / $1,258.23 / $1,709.28
| Professional | | $1,044.56 | $1,258.23 | $1,709.28 |