- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $213.39 / $390.63 / $1,020.97
| Facility | | $213.39 | $390.63 | $1,020.97 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $131.38 / $145.60 / $145.60
| Professional | | $131.38 | $145.60 | $145.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $177.56 / $209.13 / $227.28
| Facility | | $177.56 | $209.13 | $227.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $93.22 / $133.16 / $133.16
| Professional | | $93.22 | $133.16 | $133.16 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $311.12 / $471.27 / $546.92
| Facility | | $311.12 | $471.27 | $546.92 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $85.23 / $204.02 / $255.03
| Professional | | $85.23 | $204.02 | $255.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $62.15 / $106.54 / $257.88
| Professional | | $62.15 | $106.54 | $257.88 |