- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,071.52 / $2,238.72 / $5,888.44
| Facility | | $1,071.52 | $2,238.72 | $5,888.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $851.14 / $1,047.13 / $1,258.93
| Professional | | $851.14 | $1,047.13 | $1,258.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,000.00 / $2,187.76 / $6,309.57
| Facility | | $1,000.00 | $2,187.76 | $6,309.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $199.53 / $199.53 / $1,513.56
| Professional | | $199.53 | $199.53 | $1,513.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $851.14 / $2,137.96 / $5,495.41
| Facility | | $851.14 | $2,137.96 | $5,495.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,348.96 / $1,548.82 / $1,737.80
| Professional | | $1,348.96 | $1,548.82 | $1,737.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $776.25 / $1,318.26 / $1,548.82
| Facility | | $776.25 | $1,318.26 | $1,548.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $549.54 / $776.25 / $1,548.82
| Professional | | $549.54 | $776.25 | $1,548.82 |