- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $567.45 / $1,748.07 / $7,051.92
| Facility | | $567.45 | $1,748.07 | $7,051.92 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $59.74 / $60.88 / $60.88
| Professional | | $59.74 | $60.88 | $60.88 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,353.31 / $1,765.73 / $3,443.04
| Facility | | $1,353.31 | $1,765.73 | $3,443.04 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $32.90 / $74.28 / $128.09
| Facility | | $32.90 | $74.28 | $128.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $30.42 / $31.23 / $31.23
| Facility | | $30.42 | $31.23 | $31.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $27.62 / $29.60 / $31.23
| Professional | | $27.62 | $29.60 | $31.23 |