- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $371.54 / $1,122.02 / $7,585.78
| Facility | | $371.54 | $1,122.02 | $7,585.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $891.25 / $1,949.84 / $2,398.83
| Facility | | $891.25 | $1,949.84 | $2,398.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $588.84 / $645.65 / $758.58
| Professional | | $588.84 | $645.65 | $758.58 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $144.54 / $239.88 / $309.03
| Facility | | $144.54 | $239.88 | $309.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $645.65 / $645.65 / $707.95
| Professional | | $645.65 | $645.65 | $707.95 |