- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $346.74 / $691.83 / $1,202.26
| Facility | | $346.74 | $691.83 | $1,202.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $371.54 / $467.74 / $933.25
| Facility | | $371.54 | $467.74 | $933.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $354.81 / $398.11 / $457.09
| Professional | | $354.81 | $398.11 | $457.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,754.23 / $3,981.07 / $5,888.44
| Facility | | $2,754.23 | $3,981.07 | $5,888.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,511.89 / $2,570.40 / $2,818.38
| Professional | | $2,511.89 | $2,570.40 | $2,818.38 |