- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,513.56 / $4,073.80 / $12,589.25
| Facility | | $1,513.56 | $4,073.80 | $12,589.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $691.83 / $891.25 / $1,737.80
| Facility | | $691.83 | $891.25 | $1,737.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $67.61 / $123.03 / $1,778.28
| Facility | | $67.61 | $123.03 | $1,778.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $128.82 / $134.90 / $181.97
| Professional | | $128.82 | $134.90 | $181.97 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $549.54 / $1,230.27 / $4,466.84
| Facility | | $549.54 | $1,230.27 | $4,466.84 |