- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $119.74 / $132.08 / $362.01
| Facility | | $119.74 | $132.08 | $362.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $96.11 / $119.74 / $140.19
| Professional | | $96.11 | $119.74 | $140.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $111.44 / $111.44 / $232.14
| Professional | | $111.44 | $111.44 | $232.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $105.86 / $148.40 / $317.77
| Professional | | $105.86 | $148.40 | $317.77 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.52 / $252.90 / $400.61
| Professional | | $2.52 | $252.90 | $400.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.52 / $2.52 / $2.52
| Professional | | $2.52 | $2.52 | $2.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $180.81 / $279.80 / $372.29
| Professional | | $180.81 | $279.80 | $372.29 |