- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,383.69 / $1,883.65 / $6,865.98
| Facility | | $1,383.69 | $1,883.65 | $6,865.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $783.22 / $1,553.39 / $1,696.98
| Professional | | $783.22 | $1,553.39 | $1,696.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $388.50 / $410.25 / $475.00
| Professional | | $388.50 | $410.25 | $475.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,305.36 / $1,305.36 / $1,305.36
| Facility | | $1,305.36 | $1,305.36 | $1,305.36 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $848.49 / $1,051.28 / $9,910.48
| Facility | | $848.49 | $1,051.28 | $9,910.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $548.26 / $702.85 / $1,827.52
| Professional | | $548.26 | $702.85 | $1,827.52 |