- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $331.13 / $457.09 / $537.03
| Facility | | $331.13 | $457.09 | $537.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.36 / $44.67 / $537.03
| Professional | | $32.36 | $44.67 | $537.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $213.80 / $309.03 / $436.52
| Professional | | $213.80 | $309.03 | $436.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $63.10 / $77.62 / $229.09
| Facility | | $63.10 | $77.62 | $229.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $208.93 / $331.13 / $501.19
| Professional | | $208.93 | $331.13 | $501.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $39.81 / $50.12 / $70.79
| Professional | | $39.81 | $50.12 | $70.79 |