- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,000.00 / $3,090.30 / $6,760.83
| Facility | | $1,000.00 | $3,090.30 | $6,760.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $562.34 / $891.25 / $2,041.74
| Professional | | $562.34 | $891.25 | $2,041.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $954.99 / $1,659.59 / $8,912.51
| Facility | | $954.99 | $1,659.59 | $8,912.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,288.25 / $1,513.56 / $1,698.24
| Professional | | $1,288.25 | $1,513.56 | $1,698.24 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,786.30 / $7,585.78 / $10,232.93
| Facility | | $4,786.30 | $7,585.78 | $10,232.93 |