- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $380.19 / $1,047.13 / $7,585.78
| Facility | | $380.19 | $1,047.13 | $7,585.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $34.67 / $60.26 / $218.78
| Professional | | $34.67 | $60.26 | $218.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $102.33 / $128.82 / $323.59
| Facility | | $102.33 | $128.82 | $323.59 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $63.10 / $72.44 / $125.89
| Professional | | $63.10 | $72.44 | $125.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $64.57 / $64.57 / $67.61
| Facility | | $64.57 | $64.57 | $67.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $44.67 / $44.67 / $44.67
| Professional | | $44.67 | $44.67 | $44.67 |