- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $57.54 / $794.33 / $2,041.74
| Facility | | $57.54 | $794.33 | $2,041.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $38.90 / $123.03 / $239.88
| Professional | | $38.90 | $123.03 | $239.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $223.87 / $223.87 / $295.12
| Professional | | $223.87 | $223.87 | $295.12 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $54.95 / $186.21 / $346.74
| Professional | | $54.95 | $186.21 | $346.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $128.82 / $331.13 / $851.14
| Facility | | $128.82 | $331.13 | $851.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $44.67 / $154.88 / $346.74
| Professional | | $44.67 | $154.88 | $346.74 |