- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $245.47 / $245.47 / $331.13
| Facility | | $245.47 | $245.47 | $331.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $30.20 / $47.86 / $436.52
| Professional | | $30.20 | $47.86 | $436.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.95 / $3.89 / $5.37
| Professional | | $2.95 | $3.89 | $5.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $144.54 / $213.80 / $281.84
| Professional | | $144.54 | $213.80 | $281.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $181.97 / $245.47 / $316.23
| Professional | | $181.97 | $245.47 | $316.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $44.67 / $60.26 / $87.10
| Professional | | $44.67 | $60.26 | $87.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $69.18 / $69.18 / $100.00
| Professional | | $69.18 | $69.18 | $100.00 |