- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $130.47 / $476.80 / $531.73
| Facility | | $130.47 | $476.80 | $531.73 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $83.73 / $130.47 / $401.00
| Professional | | $83.73 | $130.47 | $401.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $107.37 / $145.29 / $171.33
| Professional | | $107.37 | $145.29 | $171.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $47.18 / $61.16 / $75.03
| Professional | | $47.18 | $61.16 | $75.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $117.23 / $131.37 / $166.52
| Facility | | $117.23 | $131.37 | $166.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $105.57 / $131.84 / $156.82
| Professional | | $105.57 | $131.84 | $156.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $82.68 / $112.08 / $157.19
| Professional | | $82.68 | $112.08 | $157.19 |