- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $44.67 / $478.63 / $537.03
| Facility | | $44.67 | $478.63 | $537.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.36 / $47.86 / $645.65
| Professional | | $32.36 | $47.86 | $645.65 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $151.36 / $295.12 / $537.03
| Professional | | $151.36 | $295.12 | $537.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $275.42 / $549.54 / $1,047.13
| Professional | | $275.42 | $549.54 | $1,047.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $407.38 / $407.38 / $407.38
| Professional | | $407.38 | $407.38 | $407.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $41.69 / $66.07 / $97.72
| Professional | | $41.69 | $66.07 | $97.72 |