- 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 / $870.96 / $933.25
| Professional | | $436.52 | $870.96 | $933.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $660.69 / $660.69 / $912.01
| Facility | | $660.69 | $660.69 | $912.01 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $467.74 / $537.03 / $562.34
| Facility | | $467.74 | $537.03 | $562.34 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $302.00 / $831.76 / $2,089.30
| Facility | | $302.00 | $831.76 | $2,089.30 |