- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $44.67 / $407.38 / $1,023.29
| Facility | | $44.67 | $407.38 | $1,023.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $43.65 / $43.65 / $177.83
| Professional | | $43.65 | $43.65 | $177.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $107.15 / $120.23 / $128.82
| Professional | | $107.15 | $120.23 | $128.82 |
- 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
- $44.67 / $61.66 / $125.89
| Facility | | $44.67 | $61.66 | $125.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,584.89 / $1,995.26 / $3,801.89
| Facility | | $1,584.89 | $1,995.26 | $3,801.89 |