- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,174.90 / $3,467.37 / $6,760.83
| Facility | | $1,174.90 | $3,467.37 | $6,760.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $851.14 / $1,047.13 / $1,737.80
| Professional | | $851.14 | $1,047.13 | $1,737.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,000.00 / $1,258.93 / $1,548.82
| Professional | | $1,000.00 | $1,258.93 | $1,548.82 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,000.00 / $3,162.28 / $7,079.46
| Facility | | $1,000.00 | $3,162.28 | $7,079.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $851.14 / $1,174.90 / $8,511.38
| Professional | | $851.14 | $1,174.90 | $8,511.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,148.15 / $4,073.80 / $8,128.31
| Facility | | $1,148.15 | $4,073.80 | $8,128.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $812.83 / $1,023.29 / $1,445.44
| Professional | | $812.83 | $1,023.29 | $1,445.44 |