- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,876.71 / $2,554.80 / $9,312.37
| Facility | | $1,876.71 | $2,554.80 | $9,312.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,062.29 / $2,106.87 / $2,301.63
| Professional | | $1,062.29 | $2,106.87 | $2,301.63 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,917.08 / $3,457.57 / $5,537.33
| Facility | | $1,917.08 | $3,457.57 | $5,537.33 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,770.48 / $1,770.48 / $1,770.48
| Facility | | $1,770.48 | $1,770.48 | $1,770.48 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,150.81 / $1,150.81 / $1,150.81
| Facility | | $1,150.81 | $1,150.81 | $1,150.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $637.37 / $1,062.29 / $1,770.48
| Facility | | $637.37 | $1,062.29 | $1,770.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $743.60 / $885.24 / $2,478.67
| Professional | | $743.60 | $885.24 | $2,478.67 |