- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $50.12 / $724.44 / $776.25
| Facility | | $50.12 | $724.44 | $776.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $30.20 / $47.86 / $794.33
| Professional | | $30.20 | $47.86 | $794.33 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $61.66 / $61.66 / $61.66
| Facility | | $61.66 | $61.66 | $61.66 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $338.84 / $602.56 / $1,202.26
| Professional | | $338.84 | $602.56 | $1,202.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $44.67 / $52.48 / $70.79
| Professional | | $44.67 | $52.48 | $70.79 |