- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,466.84 / $7,079.46 / $9,549.93
| Facility | | $4,466.84 | $7,079.46 | $9,549.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $676.08 / $1,380.38 / $7,413.10
| Professional | | $676.08 | $1,380.38 | $7,413.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $758.58 / $3,388.44 / $7,585.78
| Facility | | $758.58 | $3,388.44 | $7,585.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $549.54 / $549.54 / $776.25
| Facility | | $549.54 | $549.54 | $776.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $109.65 / $1,348.96 / $2,454.71
| Facility | | $109.65 | $1,348.96 | $2,454.71 |