- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $203.25 / $209.04 / $273.54
| Facility | | $203.25 | $209.04 | $273.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $12.92 / $66.41 / $126.00
| Professional | | $12.92 | $66.41 | $126.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $107.44 / $124.25 / $236.79
| Facility | | $107.44 | $124.25 | $236.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.51 / $14.55 / $37.40
| Professional | | $10.51 | $14.55 | $37.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $11.20 / $18.73 / $38.10
| Professional | | $11.20 | $18.73 | $38.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $320.00 / $1,401.00 / $6,383.00
| Facility | | $320.00 | $1,401.00 | $6,383.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.47 / $17.54 / $29.81
| Professional | | $10.47 | $17.54 | $29.81 |