- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $283.50 / $2,709.08 / $9,131.29
| Facility | | $283.50 | $2,709.08 | $9,131.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $35.74 / $59.74 / $118.26
| Professional | | $35.74 | $59.74 | $118.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $26.33 / $86.29 / $153.09
| Facility | | $26.33 | $86.29 | $153.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $17.55 / $23.40 / $26.33
| Professional | | $17.55 | $23.40 | $26.33 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $64.00 / $64.00 / $64.00
| Facility | | $64.00 | $64.00 | $64.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $45.06 / $45.06 / $45.06
| Professional | | $45.06 | $45.06 | $45.06 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $38.85 / $65.70 / $126.41
| Facility | | $38.85 | $65.70 | $126.41 |