- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $102.33 / $275.42 / $537.03
| Facility | | $102.33 | $275.42 | $537.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $38.90 / $109.65 / $208.93
| Professional | | $38.90 | $109.65 | $208.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $61.66 / $177.83 / $489.78
| Professional | | $61.66 | $177.83 | $489.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $147.91 / $562.34 / $794.33
| Facility | | $147.91 | $562.34 | $794.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $50.12 / $138.04 / $295.12
| Professional | | $50.12 | $138.04 | $295.12 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $151.36 / $208.93 / $275.42
| Professional | | $151.36 | $208.93 | $275.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $40.74 / $114.82 / $234.42
| Professional | | $40.74 | $114.82 | $234.42 |