- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,023.29 / $2,344.23 / $6,025.60
| Facility | | $1,023.29 | $2,344.23 | $6,025.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $870.96 / $1,071.52 / $1,819.70
| Professional | | $870.96 | $1,071.52 | $1,819.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,047.13 / $2,570.40 / $3,630.78
| Facility | | $1,047.13 | $2,570.40 | $3,630.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $831.76 / $1,230.27 / $2,290.87
| Professional | | $831.76 | $1,230.27 | $2,290.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $977.24 / $2,570.40 / $5,495.41
| Facility | | $977.24 | $2,570.40 | $5,495.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,000.00 / $1,584.89 / $2,754.23
| Professional | | $1,000.00 | $1,584.89 | $2,754.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,000.00 / $2,041.74 / $3,630.78
| Facility | | $1,000.00 | $2,041.74 | $3,630.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $870.96 / $1,258.93 / $2,290.87
| Professional | | $870.96 | $1,258.93 | $2,290.87 |