- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,090.73 / $3,706.14 / $15,000.00
| Facility | | $2,090.73 | $3,706.14 | $15,000.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $201.82 / $349.70 / $372.61
| Professional | | $201.82 | $349.70 | $372.61 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,228.64 / $1,368.33 / $1,867.85
| Facility | | $1,228.64 | $1,368.33 | $1,867.85 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,069.00 / $1,788.00 / $4,602.00
| Facility | | $1,069.00 | $1,788.00 | $4,602.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $358.87 / $485.57 / $749.66
| Professional | | $358.87 | $485.57 | $749.66 |