- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,071.52 / $1,698.24 / $2,454.71
| Facility | | $1,071.52 | $1,698.24 | $2,454.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $269.15 / $575.44 / $954.99
| Professional | | $269.15 | $575.44 | $954.99 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,248.07 / $5,248.07 / $7,244.36
| Facility | | $5,248.07 | $5,248.07 | $7,244.36 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $512.86 / $562.34 / $3,801.89
| Facility | | $512.86 | $562.34 | $3,801.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,548.82 / $2,951.21 / $9,549.93
| Facility | | $1,548.82 | $2,951.21 | $9,549.93 |