- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $45.71 / $269.15 / $1,905.46
| Facility | | $45.71 | $269.15 | $1,905.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $44.67 / $125.89 / $165.96
| Professional | | $44.67 | $125.89 | $165.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $123.03 / $123.03 / $123.03
| Professional | | $123.03 | $123.03 | $123.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,258.93 / $1,548.82 / $1,584.89
| Facility | | $1,258.93 | $1,548.82 | $1,584.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $436.52 / $436.52 / $5,011.87
| Facility | | $436.52 | $436.52 | $5,011.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $81.28 / $81.28 / $194.98
| Professional | | $81.28 | $81.28 | $194.98 |