- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $64.01 / $650.57 / $1,114.07
| Facility | | $64.01 | $650.57 | $1,114.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $37.71 / $56.38 / $145.07
| Professional | | $37.71 | $56.38 | $145.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $81.54 / $105.59 / $150.22
| Professional | | $81.54 | $105.59 | $150.22 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $62.83 / $106.38 / $186.71
| Professional | | $62.83 | $106.38 | $186.71 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $43.44 / $69.53 / $192.03
| Facility | | $43.44 | $69.53 | $192.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $65.68 / $117.43 / $312.00
| Professional | | $65.68 | $117.43 | $312.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $65.68 / $113.28 / $144.50
| Professional | | $65.68 | $113.28 | $144.50 |