- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $76.27 / $414.68 / $998.20
| Facility | | $76.27 | $414.68 | $998.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $28.03 / $126.38 / $162.11
| Professional | | $28.03 | $126.38 | $162.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $30.29 / $67.81 / $232.00
| Professional | | $30.29 | $67.81 | $232.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $462.06 / $462.06 / $514.83
| Facility | | $462.06 | $462.06 | $514.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $52.02 / $52.02 / $52.02
| Professional | | $52.02 | $52.02 | $52.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $135.65 / $175.55 / $345.19
| Professional | | $135.65 | $175.55 | $345.19 |