- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $84.55 / $152.85 / $434.15
| Facility | | $84.55 | $152.85 | $434.15 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $20.72 / $25.68 / $37.00
| Professional | | $20.72 | $25.68 | $37.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $50.00 / $50.76 / $60.92
| Facility | | $50.00 | $50.76 | $60.92 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $37.00 / $46.00 / $95.00
| Professional | | $37.00 | $46.00 | $95.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $59.32 / $59.32 / $59.32
| Facility | | $59.32 | $59.32 | $59.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $18.22 / $34.28 / $42.85
| Professional | | $18.22 | $34.28 | $42.85 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $12.43 / $17.09 / $41.36
| Professional | | $12.43 | $17.09 | $41.36 |