- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $114.79 / $129.10 / $402.02
| Facility | | $114.79 | $129.10 | $402.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $49.27 / $49.27 / $51.24
| Professional | | $49.27 | $49.27 | $51.24 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $52.55 / $52.55 / $233.26
| Professional | | $52.55 | $52.55 | $233.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $106.75 / $111.02 / $239.26
| Facility | | $106.75 | $111.02 | $239.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $39.67 / $147.62 / $512.32
| Professional | | $39.67 | $147.62 | $512.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $75.54 / $133.53 / $133.53
| Professional | | $75.54 | $133.53 | $133.53 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $27.59 / $53.20 / $106.74
| Professional | | $27.59 | $53.20 | $106.74 |