- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,230.27 / $2,137.96 / $7,762.47
| Facility | | $1,230.27 | $2,137.96 | $7,762.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $977.24 / $1,148.15 / $1,778.28
| Professional | | $977.24 | $1,148.15 | $1,778.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,000.00 / $1,230.27 / $1,584.89
| Professional | | $1,000.00 | $1,230.27 | $1,584.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $912.01 / $1,202.26 / $2,951.21
| Professional | | $912.01 | $1,202.26 | $2,951.21 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,047.13 / $1,122.02 / $2,398.83
| Professional | | $1,047.13 | $1,122.02 | $2,398.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $645.65 / $2,290.87 / $6,309.57
| Facility | | $645.65 | $2,290.87 | $6,309.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $851.14 / $1,148.15 / $2,630.27
| Professional | | $851.14 | $1,148.15 | $2,630.27 |