- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $44.67 / $346.74 / $3,890.45
| Facility | | $44.67 | $346.74 | $3,890.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $43.65 / $43.65 / $177.83
| Professional | | $43.65 | $43.65 | $177.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $524.81 / $524.81 / $707.95
| Facility | | $524.81 | $524.81 | $707.95 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $87.10 / $87.10 / $87.10
| Facility | | $87.10 | $87.10 | $87.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $346.74 / $346.74 / $346.74
| Professional | | $346.74 | $346.74 | $346.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $724.44 / $933.25 / $1,778.28
| Facility | | $724.44 | $933.25 | $1,778.28 |