- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,518.41 / $3,706.14 / $8,739.83
| Facility | | $1,518.41 | $3,706.14 | $8,739.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $105.42 / $120.14 / $182.93
| Professional | | $105.42 | $120.14 | $182.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $0.02 / $165.75 / $165.75
| Professional | | $0.02 | $165.75 | $165.75 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $143.69 / $196.70 / $244.87
| Professional | | $143.69 | $196.70 | $244.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $540.00 / $1,401.00 / $4,915.00
| Facility | | $540.00 | $1,401.00 | $4,915.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $102.77 / $171.81 / $261.42
| Professional | | $102.77 | $171.81 | $261.42 |