- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,071.52 / $1,071.52 / $2,290.87
| Facility | | $1,071.52 | $1,071.52 | $2,290.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $954.99 / $1,122.02 / $1,584.89
| Professional | | $954.99 | $1,122.02 | $1,584.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,819.70 / $1,819.70 / $2,290.87
| Facility | | $1,819.70 | $1,819.70 | $2,290.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,023.29 / $1,479.11 / $6,606.93
| Professional | | $1,023.29 | $1,479.11 | $6,606.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,454.71 / $2,454.71 / $9,772.37
| Facility | | $2,454.71 | $2,454.71 | $9,772.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $851.14 / $1,174.90 / $1,862.09
| Professional | | $851.14 | $1,174.90 | $1,862.09 |