- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,071.52 / $2,041.74 / $2,818.38
| Facility | | $1,071.52 | $2,041.74 | $2,818.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $891.25 / $1,513.56 / $1,905.46
| Professional | | $891.25 | $1,513.56 | $1,905.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,964.78 / $10,964.78 / $14,791.08
| Facility | | $10,964.78 | $10,964.78 | $14,791.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,187.76 / $5,888.44 / $16,595.87
| Facility | | $2,187.76 | $5,888.44 | $16,595.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,318.26 / $1,698.24 / $3,019.95
| Professional | | $1,318.26 | $1,698.24 | $3,019.95 |