- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,071.52 / $1,445.44 / $2,454.71
| Facility | | $1,071.52 | $1,445.44 | $2,454.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $309.03 / $1,047.13 / $4,570.88
| Professional | | $309.03 | $1,047.13 | $4,570.88 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $588.84 / $588.84 / $812.83
| Facility | | $588.84 | $588.84 | $812.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $61.66 / $61.66 / $61.66
| Facility | | $61.66 | $61.66 | $61.66 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $331.13 / $831.76 / $1,862.09
| Facility | | $331.13 | $831.76 | $1,862.09 |