- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,000.00 / $8,942.39 / $14,860.56
| Facility | | $1,000.00 | $8,942.39 | $14,860.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $563.33 / $574.34 / $597.47
| Professional | | $563.33 | $574.34 | $597.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $60.00 / $85.00 / $906.83
| Professional | | $60.00 | $85.00 | $906.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $748.15 / $748.15 / $748.15
| Facility | | $748.15 | $748.15 | $748.15 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,609.00 / $21,608.00 / $23,186.00
| Facility | | $10,609.00 | $21,608.00 | $23,186.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $794.70 / $953.65 / $1,395.15
| Professional | | $794.70 | $953.65 | $1,395.15 |