- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $170.05 / $241.28 / $580.41
| Facility | | $170.05 | $241.28 | $580.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $126.37 / $196.71 / $291.07
| Professional | | $126.37 | $196.71 | $291.07 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $133.97 / $220.58 / $457.03
| Facility | | $133.97 | $220.58 | $457.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $114.41 / $170.47 / $258.69
| Professional | | $114.41 | $170.47 | $258.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $500.00 / $500.00 / $500.00
| Professional | | $500.00 | $500.00 | $500.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $87.54 / $87.54 / $87.54
| Professional | | $87.54 | $87.54 | $87.54 |