- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $758.58 / $1,445.44 / $2,454.71
| Facility | | $758.58 | $1,445.44 | $2,454.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $83.18 / $134.90 / $218.78
| Professional | | $83.18 | $134.90 | $218.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $61.66 / $61.66 / $85.11
| Facility | | $61.66 | $61.66 | $85.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $95.50 / $275.42 / $776.25
| Facility | | $95.50 | $275.42 | $776.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $134.90 / $158.49 / $257.04
| Professional | | $134.90 | $158.49 | $257.04 |