- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $213.80 / $302.00 / $724.44
| Facility | | $213.80 | $302.00 | $724.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $123.03 / $154.88 / $239.88
| Professional | | $123.03 | $154.88 | $239.88 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $234.42 / $288.40 / $562.34
| Facility | | $234.42 | $288.40 | $562.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $120.23 / $120.23 / $190.55
| Professional | | $120.23 | $120.23 | $190.55 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $169.82 / $208.93 / $218.78
| Facility | | $169.82 | $208.93 | $218.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $213.80 / $912.01 / $912.01
| Professional | | $213.80 | $912.01 | $912.01 |