- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,174.90 / $1,819.70 / $2,511.89
| Facility | | $1,174.90 | $1,819.70 | $2,511.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $436.52 / $630.96 / $933.25
| Professional | | $436.52 | $630.96 | $933.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $851.14 / $851.14 / $1,148.15
| Facility | | $851.14 | $851.14 | $1,148.15 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $512.86 / $537.03 / $562.34
| Facility | | $512.86 | $537.03 | $562.34 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $302.00 / $831.76 / $2,630.27
| Facility | | $302.00 | $831.76 | $2,630.27 |