- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,280.44 / $1,280.44 / $1,536.53
| Facility | | $1,280.44 | $1,280.44 | $1,536.53 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $935.88 / $993.59 / $1,380.31
| Professional | | $935.88 | $993.59 | $1,380.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,274.06 / $2,274.06 / $2,695.67
| Facility | | $2,274.06 | $2,274.06 | $2,695.67 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,250.07 / $1,250.07 / $1,328.20
| Professional | | $1,250.07 | $1,250.07 | $1,328.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,300.55 / $1,300.55 / $1,300.55
| Facility | | $1,300.55 | $1,300.55 | $1,300.55 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $949.40 / $949.40 / $1,300.55
| Professional | | $949.40 | $949.40 | $1,300.55 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,841.20 / $1,841.20 / $5,682.86
| Professional | | $1,841.20 | $1,841.20 | $5,682.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $756.33 / $1,134.50 / $1,347.07
| Professional | | $756.33 | $1,134.50 | $1,347.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,485.76 / $1,634.34 / $2,080.06
| Professional | | $1,485.76 | $1,634.34 | $2,080.06 |