- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $331.13 / $331.13 / $354.81
| Facility | | $331.13 | $331.13 | $354.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.36 / $77.62 / $239.88
| Professional | | $32.36 | $77.62 | $239.88 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $234.42 / $263.03 / $295.12
| Facility | | $234.42 | $263.03 | $295.12 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $93.33 / $93.33 / $223.87
| Professional | | $93.33 | $93.33 | $223.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $26.30 / $57.54 / $138.04
| Professional | | $26.30 | $57.54 | $138.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $34.67 / $83.18 / $194.98
| Professional | | $34.67 | $83.18 | $194.98 |