- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,408.65 / $1,408.65 / $3,034.47
| Facility | | $1,408.65 | $1,408.65 | $3,034.47 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,988.10 / $1,988.10 / $1,988.10
| Facility | | $1,988.10 | $1,988.10 | $1,988.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,569.56 / $2,092.73 / $2,354.34
| Professional | | $1,569.56 | $2,092.73 | $2,354.34 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,133.57 / $1,314.94 / $3,128.65
| Facility | | $1,133.57 | $1,314.94 | $3,128.65 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,006.18 / $1,006.18 / $1,006.18
| Facility | | $1,006.18 | $1,006.18 | $1,006.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $469.55 / $670.79 / $1,520.45
| Professional | | $469.55 | $670.79 | $1,520.45 |