- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $50.52 / $240.73 / $468.84
| Facility | | $50.52 | $240.73 | $468.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $50.52 / $50.52 / $50.52
| Professional | | $50.52 | $50.52 | $50.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $60.62 / $294.56 / $673.70
| Professional | | $60.62 | $294.56 | $673.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $109.45 / $113.83 / $245.21
| Facility | | $109.45 | $113.83 | $245.21 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $36.90 / $77.23 / $96.54
| Professional | | $36.90 | $77.23 | $96.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $136.91 / $136.91 / $136.91
| Professional | | $136.91 | $136.91 | $136.91 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $30.31 / $41.31 / $61.30
| Professional | | $30.31 | $41.31 | $61.30 |