- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $390.18 / $903.37 / $1,182.11
| Facility | | $390.18 | $903.37 | $1,182.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $89.67 / $100.54 / $115.48
| Professional | | $89.67 | $100.54 | $115.48 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $116.13 / $119.44 / $374.35
| Facility | | $116.13 | $119.44 | $374.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $85.55 / $156.11 / $195.14
| Professional | | $85.55 | $156.11 | $195.14 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $135.86 / $156.24 / $611.39
| Facility | | $135.86 | $156.24 | $611.39 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $104.00 / $110.70 / $156.81
| Professional | | $104.00 | $110.70 | $156.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $57.06 / $80.30 / $81.52
| Professional | | $57.06 | $80.30 | $81.52 |