- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,174.90 / $2,041.74 / $5,370.32
| Facility | | $1,174.90 | $2,041.74 | $5,370.32 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $371.54 / $1,096.48 / $3,019.95
| Facility | | $371.54 | $1,096.48 | $3,019.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $512.86 / $794.33 / $1,174.90
| Professional | | $512.86 | $794.33 | $1,174.90 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $426.58 / $457.09 / $489.78
| Facility | | $426.58 | $457.09 | $489.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $309.03 / $446.68 / $741.31
| Professional | | $309.03 | $446.68 | $741.31 |