- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $363.08 / $416.87 / $537.03
| Facility | | $363.08 | $416.87 | $537.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $30.20 / $50.12 / $1,230.27
| Professional | | $30.20 | $50.12 | $1,230.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $389.05 / $446.68 / $512.86
| Professional | | $389.05 | $446.68 | $512.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $223.87 / $398.11 / $512.86
| Professional | | $223.87 | $398.11 | $512.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $50.12 / $66.07 / $97.72
| Professional | | $50.12 | $66.07 | $97.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $50.12 / $70.79 / $97.72
| Professional | | $50.12 | $70.79 | $97.72 |