- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,230.27 / $2,818.38 / $6,309.57
| Facility | | $1,230.27 | $2,818.38 | $6,309.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $524.81 / $1,258.93 / $8,912.51
| Professional | | $524.81 | $1,258.93 | $8,912.51 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $549.54 / $1,778.28 / $2,691.53
| Facility | | $549.54 | $1,778.28 | $2,691.53 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $169.82 / $190.55 / $537.03
| Professional | | $169.82 | $190.55 | $537.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $707.95 / $1,412.54 / $2,238.72
| Facility | | $707.95 | $1,412.54 | $2,238.72 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $165.96 / $1,122.02 / $2,187.76
| Facility | | $165.96 | $1,122.02 | $2,187.76 |