- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,445.44 / $3,090.30 / $6,309.57
| Facility | | $1,445.44 | $3,090.30 | $6,309.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $229.09 / $1,698.24 / $1,949.84
| Professional | | $229.09 | $1,698.24 | $1,949.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $758.58 / $2,454.71 / $3,630.78
| Facility | | $758.58 | $2,454.71 | $3,630.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $295.12 / $331.13 / $933.25
| Professional | | $295.12 | $331.13 | $933.25 |
- 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
- $169.82 / $1,122.02 / $2,187.76
| Facility | | $169.82 | $1,122.02 | $2,187.76 |