- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,623.41 / $10,715.19 / $18,620.87
| Facility | | $5,623.41 | $10,715.19 | $18,620.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $691.83 / $933.25 / $2,290.87
| Facility | | $691.83 | $933.25 | $2,290.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $288.40 / $316.23 / $363.08
| Professional | | $288.40 | $316.23 | $363.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $724.44 / $2,137.96 / $6,456.54
| Facility | | $724.44 | $2,137.96 | $6,456.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $630.96 / $891.25 / $1,380.38
| Professional | | $630.96 | $891.25 | $1,380.38 |