- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $134.90 / $257.04 / $3,235.94
| Facility | | $134.90 | $257.04 | $3,235.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $51.29 / $109.65 / $245.47
| Professional | | $51.29 | $109.65 | $245.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $64.57 / $91.20 / $162.18
| Professional | | $64.57 | $91.20 | $162.18 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $338.84 / $1,230.27 / $2,187.76
| Facility | | $338.84 | $1,230.27 | $2,187.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $501.19 / $501.19 / $501.19
| Facility | | $501.19 | $501.19 | $501.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $60.26 / $97.72 / $165.96
| Professional | | $60.26 | $97.72 | $165.96 |