- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $43.50 / $134.53 / $10,703.28
| Facility | | $43.50 | $134.53 | $10,703.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $45.13 / $48.74 / $52.35
| Professional | | $45.13 | $48.74 | $52.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $38.46 / $58.07 / $69.98
| Professional | | $38.46 | $58.07 | $69.98 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $225.36 / $225.36 / $225.36
| Facility | | $225.36 | $225.36 | $225.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $45.48 / $59.05 / $113.50
| Professional | | $45.48 | $59.05 | $113.50 |