- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $118.37 / $164.03 / $506.00
| Facility | | $118.37 | $164.03 | $506.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $95.56 / $118.37 / $118.38
| Professional | | $95.56 | $118.37 | $118.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $72.64 / $80.45 / $213.02
| Professional | | $72.64 | $80.45 | $213.02 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $295.75 / $295.75 / $667.15
| Facility | | $295.75 | $295.75 | $667.15 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $123.00 / $123.00 / $123.00
| Professional | | $123.00 | $123.00 | $123.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $59.90 / $85.58 / $313.79
| Professional | | $59.90 | $85.58 | $313.79 |