- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,071.52 / $1,819.70 / $6,918.31
| Facility | | $1,071.52 | $1,819.70 | $6,918.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $194.98 / $323.59 / $501.19
| Professional | | $194.98 | $323.59 | $501.19 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $645.65 / $645.65 / $891.25
| Facility | | $645.65 | $645.65 | $891.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $331.13 / $831.76 / $1,862.09
| Facility | | $331.13 | $831.76 | $1,862.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $295.12 / $407.38 / $660.69
| Professional | | $295.12 | $407.38 | $660.69 |