- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $76.44 / $3,431.61 / $6,077.36
| Facility | | $76.44 | $3,431.61 | $6,077.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $76.44 / $142.53 / $788.49
| Professional | | $76.44 | $142.53 | $788.49 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $195.78 / $195.78 / $195.78
| Facility | | $195.78 | $195.78 | $195.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $166.41 / $166.41 / $290.12
| Professional | | $166.41 | $166.41 | $290.12 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $60.00 / $193.35 / $251.35
| Professional | | $60.00 | $193.35 | $251.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $147.29 / $185.40 / $278.10
| Professional | | $147.29 | $185.40 | $278.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $106.91 / $118.40 / $169.87
| Professional | | $106.91 | $118.40 | $169.87 |