- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $30.20 / $323.59 / $371.54
| Facility | | $30.20 | $323.59 | $371.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $30.20 / $47.86 / $467.74
| Professional | | $30.20 | $47.86 | $467.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $151.36 / $213.80 / $323.59
| Professional | | $151.36 | $213.80 | $323.59 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $190.55 / $407.38 / $660.69
| Professional | | $190.55 | $407.38 | $660.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6.03 / $23.44 / $81.28
| Professional | | $6.03 | $23.44 | $81.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $50.12 / $67.61 / $89.13
| Professional | | $50.12 | $67.61 | $89.13 |