- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $139.56 / $255.64 / $966.37
| Professional | | $139.56 | $255.64 | $966.37 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,135.74 / $2,492.07 / $2,605.60
| Facility | | $1,135.74 | $2,492.07 | $2,605.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $251.55 / $251.55 / $251.55
| Facility | | $251.55 | $251.55 | $251.55 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $104.09 / $281.70 / $635.78
| Professional | | $104.09 | $281.70 | $635.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $251.55 / $251.55 / $251.55
| Facility | | $251.55 | $251.55 | $251.55 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $120.60 / $281.70 / $635.78
| Professional | | $120.60 | $281.70 | $635.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $93.78 / $204.68 / $347.23
| Professional | | $93.78 | $204.68 | $347.23 |