- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,148.15 / $4,265.80 / $8,511.38
| Facility | | $1,148.15 | $4,265.80 | $8,511.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $181.97 / $346.74 / $524.81
| Professional | | $181.97 | $346.74 | $524.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,128.61 / $6,606.93 / $12,882.50
| Facility | | $5,128.61 | $6,606.93 | $12,882.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $776.25 / $1,778.28 / $6,165.95
| Facility | | $776.25 | $1,778.28 | $6,165.95 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $776.25 / $1,819.70 / $6,309.57
| Facility | | $776.25 | $1,819.70 | $6,309.57 |