- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,000.00 / $2,145.78 / $7,838.38
| Facility | | $1,000.00 | $2,145.78 | $7,838.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $126.98 / $129.63 / $134.83
| Professional | | $126.98 | $129.63 | $134.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $60.00 / $85.00 / $3,643.42
| Professional | | $60.00 | $85.00 | $3,643.42 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $168.50 / $168.50 / $168.50
| Facility | | $168.50 | $168.50 | $168.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,824.00 / $2,516.00 / $2,655.00
| Facility | | $1,824.00 | $2,516.00 | $2,655.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $191.67 / $234.69 / $344.79
| Professional | | $191.67 | $234.69 | $344.79 |