- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $56.23 / $616.60 / $616.60
| Facility | | $56.23 | $616.60 | $616.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $34.67 / $56.23 / $630.96
| Professional | | $34.67 | $56.23 | $630.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $251.19 / $323.59 / $436.52
| Professional | | $251.19 | $323.59 | $436.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $141.25 / $316.23 / $575.44
| Professional | | $141.25 | $316.23 | $575.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $346.74 / $426.58 / $537.03
| Professional | | $346.74 | $426.58 | $537.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $38.02 / $50.12 / $79.43
| Professional | | $38.02 | $50.12 | $79.43 |