- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,344.23 / $5,011.87 / $12,589.25
| Facility | | $2,344.23 | $5,011.87 | $12,589.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $891.25 / $1,174.90 / $2,290.87
| Facility | | $891.25 | $1,174.90 | $2,290.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $177.83 / $416.87 / $1,995.26
| Facility | | $177.83 | $416.87 | $1,995.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $371.54 / $446.68 / $588.84
| Professional | | $371.54 | $446.68 | $588.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $501.19 / $1,230.27 / $4,466.84
| Facility | | $501.19 | $1,230.27 | $4,466.84 |