- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $127.41 / $454.03 / $641.86
| Facility | | $127.41 | $454.03 | $641.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $52.65 / $52.65 / $83.95
| Professional | | $52.65 | $52.65 | $83.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $56.16 / $77.00 / $393.26
| Professional | | $56.16 | $77.00 | $393.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $114.08 / $118.64 / $254.74
| Facility | | $114.08 | $118.64 | $254.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $52.27 / $81.34 / $547.37
| Professional | | $52.27 | $81.34 | $547.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $80.73 / $142.69 / $142.69
| Professional | | $80.73 | $142.69 | $142.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $29.48 / $42.12 / $152.26
| Professional | | $29.48 | $42.12 | $152.26 |