- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $75.86 / $281.84 / $8,709.64
| Facility | | $75.86 | $281.84 | $8,709.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $144.54 / $144.54 / $151.36
| Professional | | $144.54 | $144.54 | $151.36 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $70.79 / $95.50 / $125.89
| Facility | | $70.79 | $95.50 | $125.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,737.80 / $3,890.45 / $6,760.83
| Facility | | $1,737.80 | $3,890.45 | $6,760.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $56.23 / $1,288.25 / $1,288.25
| Facility | | $56.23 | $1,288.25 | $1,288.25 |