- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,412.54 / $2,187.76 / $10,471.29
| Facility | | $1,412.54 | $2,187.76 | $10,471.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $691.83 / $1,584.89 / $2,089.30
| Facility | | $691.83 | $1,584.89 | $2,089.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $512.86 / $602.56 / $645.65
| Professional | | $512.86 | $602.56 | $645.65 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $363.08 / $489.78 / $977.24
| Facility | | $363.08 | $489.78 | $977.24 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $489.78 / $512.86 / $575.44
| Professional | | $489.78 | $512.86 | $575.44 |