- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $44.67 / $562.34 / $616.60
| Facility | | $44.67 | $562.34 | $616.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.36 / $47.86 / $741.31
| Professional | | $32.36 | $47.86 | $741.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $177.83 / $323.59 / $537.03
| Professional | | $177.83 | $323.59 | $537.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $302.00 / $426.58 / $602.56
| Professional | | $302.00 | $426.58 | $602.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $478.63 / $478.63 / $478.63
| Professional | | $478.63 | $478.63 | $478.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $41.69 / $66.07 / $97.72
| Professional | | $41.69 | $66.07 | $97.72 |