- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $346.80 / $1,817.23 / $2,382.52
| Facility | | $346.80 | $1,817.23 | $2,382.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $346.80 / $401.62 / $436.35
| Professional | | $346.80 | $401.62 | $436.35 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $143.07 / $143.07 / $143.07
| Facility | | $143.07 | $143.07 | $143.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $280.01 / $280.01 / $350.02
| Professional | | $280.01 | $280.01 | $350.02 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $246.73 / $323.85 / $471.95
| Facility | | $246.73 | $323.85 | $471.95 |