- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $794.33 / $1,318.26 / $2,511.89
| Facility | | $794.33 | $1,318.26 | $2,511.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $190.55 / $575.44 / $933.25
| Professional | | $190.55 | $575.44 | $933.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $831.76 / $831.76 / $1,148.15
| Facility | | $831.76 | $831.76 | $1,148.15 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $512.86 / $562.34 / $891.25
| Facility | | $512.86 | $562.34 | $891.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $537.03 / $1,230.27 / $2,570.40
| Facility | | $537.03 | $1,230.27 | $2,570.40 |