- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,000.00 / $1,258.93 / $2,041.74
| Professional | | $1,000.00 | $1,258.93 | $2,041.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,698.24 / $1,698.24 / $1,698.24
| Professional | | $1,698.24 | $1,698.24 | $1,698.24 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,513.56 / $1,513.56 / $4,168.69
| Facility | | $1,513.56 | $1,513.56 | $4,168.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,096.48 / $1,096.48 / $2,818.38
| Professional | | $1,096.48 | $1,096.48 | $2,818.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $776.25 / $1,348.96 / $3,090.30
| Facility | | $776.25 | $1,348.96 | $3,090.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $758.58 / $1,071.52 / $1,621.81
| Professional | | $758.58 | $1,071.52 | $1,621.81 |