- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $218.10 / $239.91 / $349.44
| Facility | | $218.10 | $239.91 | $349.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $58.34 / $217.25 / $325.58
| Professional | | $58.34 | $217.25 | $325.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $46.72 / $156.06 / $243.85
| Professional | | $46.72 | $156.06 | $243.85 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $211.34 / $218.10 / $467.77
| Facility | | $211.34 | $218.10 | $467.77 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $114.32 / $351.51 / $1,345.11
| Professional | | $114.32 | $351.51 | $1,345.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $281.20 / $351.51 / $600.73
| Professional | | $281.20 | $351.51 | $600.73 |