- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $44.67 / $323.59 / $354.81
| Facility | | $44.67 | $323.59 | $354.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.36 / $47.86 / $426.58
| Professional | | $32.36 | $47.86 | $426.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $102.33 / $181.97 / $309.03
| Professional | | $102.33 | $181.97 | $309.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $151.36 / $213.80 / $302.00
| Professional | | $151.36 | $213.80 | $302.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $269.15 / $269.15 / $269.15
| Professional | | $269.15 | $269.15 | $269.15 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $41.69 / $66.07 / $97.72
| Professional | | $41.69 | $66.07 | $97.72 |