- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $426.58 / $426.58 / $575.44
| Facility | | $426.58 | $426.58 | $575.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $30.20 / $50.12 / $776.25
| Professional | | $30.20 | $50.12 | $776.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3.16 / $4.27 / $6.31
| Professional | | $3.16 | $4.27 | $6.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $288.40 / $426.58 / $562.34
| Professional | | $288.40 | $426.58 | $562.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $316.23 / $436.52 / $549.54
| Professional | | $316.23 | $436.52 | $549.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $44.67 / $60.26 / $87.10
| Professional | | $44.67 | $60.26 | $87.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $120.23 / $120.23 / $173.78
| Professional | | $120.23 | $120.23 | $173.78 |