- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $40.88 / $150.72 / $163.97
| Facility | | $40.88 | $150.72 | $163.97 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $108.50 / $136.63 / $160.47
| Professional | | $108.50 | $136.63 | $160.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $127.00 / $127.00 / $173.74
| Professional | | $127.00 | $127.00 | $173.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $118.66 / $153.27 / $245.31
| Professional | | $118.66 | $153.27 | $245.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1.07 / $33.49 / $71.44
| Professional | | $1.07 | $33.49 | $71.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1.07 / $1.07 / $1.07
| Professional | | $1.07 | $1.07 | $1.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $105.72 / $154.11 / $218.51
| Professional | | $105.72 | $154.11 | $218.51 |