- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $80.59 / $103.01 / $2,057.15
| Facility | | $80.59 | $103.01 | $2,057.15 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $57.79 / $80.61 / $91.98
| Professional | | $57.79 | $80.61 | $91.98 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $198.03 / $240.32 / $323.31
| Facility | | $198.03 | $240.32 | $323.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $67.45 / $67.45 / $107.33
| Professional | | $67.45 | $67.45 | $107.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $70.18 / $70.18 / $80.88
| Professional | | $70.18 | $70.18 | $80.88 |