- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,621.81 / $2,187.76 / $7,762.47
| Facility | | $1,621.81 | $2,187.76 | $7,762.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $912.01 / $1,318.26 / $1,995.26
| Professional | | $912.01 | $1,318.26 | $1,995.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,659.59 / $2,951.21 / $4,786.30
| Facility | | $1,659.59 | $2,951.21 | $4,786.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $602.56 / $602.56 / $602.56
| Professional | | $602.56 | $602.56 | $602.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,513.56 / $1,513.56 / $1,513.56
| Facility | | $1,513.56 | $1,513.56 | $1,513.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $977.24 / $1,174.90 / $11,481.54
| Facility | | $977.24 | $1,174.90 | $11,481.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $630.96 / $1,513.56 / $1,513.56
| Facility | | $630.96 | $1,513.56 | $1,513.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $630.96 / $758.58 / $2,137.96
| Professional | | $630.96 | $758.58 | $2,137.96 |