- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,621.81 / $2,754.23 / $9,549.93
| Facility | | $1,621.81 | $2,754.23 | $9,549.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,202.26 / $2,630.27 / $3,235.94
| Facility | | $1,202.26 | $2,630.27 | $3,235.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $794.33 / $933.25 / $1,023.29
| Professional | | $794.33 | $933.25 | $1,023.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $912.01 / $1,513.56 / $1,778.28
| Facility | | $912.01 | $1,513.56 | $1,778.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $891.25 / $891.25 / $1,071.52
| Professional | | $891.25 | $891.25 | $1,071.52 |