- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $332.17 / $1,740.57 / $2,282.01
| Facility | | $332.17 | $1,740.57 | $2,282.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $283.45 / $299.83 / $381.65
| Professional | | $283.45 | $299.83 | $381.65 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $45.39 / $45.39 / $45.39
| Facility | | $45.39 | $45.39 | $45.39 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $109.45 / $109.45 / $136.81
| Professional | | $109.45 | $109.45 | $136.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $82.20 / $103.83 / $149.72
| Facility | | $82.20 | $103.83 | $149.72 |