- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $128.12 / $671.35 / $880.18
| Facility | | $128.12 | $671.35 | $880.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $106.76 / $213.77 / $327.78
| Professional | | $106.76 | $213.77 | $327.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $243.63 / $250.57 / $785.36
| Facility | | $243.63 | $250.57 | $785.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $54.54 / $327.51 / $409.39
| Professional | | $54.54 | $327.51 | $409.39 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $285.02 / $327.78 / $1,154.36
| Facility | | $285.02 | $327.78 | $1,154.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $218.18 / $232.25 / $328.78
| Professional | | $218.18 | $232.25 | $328.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $60.19 / $119.71 / $171.02
| Professional | | $60.19 | $119.71 | $171.02 |