- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $154.88 / $5,248.07 / $8,709.64
| Facility | | $154.88 | $5,248.07 | $8,709.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $50.12 / $173.78 / $512.86
| Professional | | $50.12 | $173.78 | $512.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $52.48 / $208.93 / $602.56
| Professional | | $52.48 | $208.93 | $602.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $154.88 / $165.96 / $186.21
| Facility | | $154.88 | $165.96 | $186.21 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $302.00 / $758.58 / $1,949.84
| Facility | | $302.00 | $758.58 | $1,949.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $44.67 / $67.61 / $154.88
| Professional | | $44.67 | $67.61 | $154.88 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,659.59 / $1,659.59 / $1,659.59
| Facility | | $1,659.59 | $1,659.59 | $1,659.59 |