- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,096.48 / $1,445.44 / $2,398.83
| Facility | | $1,096.48 | $1,445.44 | $2,398.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $141.25 / $177.83 / $223.87
| Professional | | $141.25 | $177.83 | $223.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $512.86 / $616.60 / $831.76
| Facility | | $512.86 | $616.60 | $831.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $239.88 / $562.34 / $1,548.82
| Facility | | $239.88 | $562.34 | $1,548.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $234.42 / $288.40 / $389.05
| Professional | | $234.42 | $288.40 | $389.05 |