- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $48.31 / $230.20 / $448.38
| Facility | | $48.31 | $230.20 | $448.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $48.31 / $48.31 / $48.31
| Professional | | $48.31 | $48.31 | $48.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $51.53 / $281.67 / $644.16
| Professional | | $51.53 | $281.67 | $644.16 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $104.68 / $108.86 / $234.50
| Facility | | $104.68 | $108.86 | $234.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $35.36 / $73.93 / $92.41
| Professional | | $35.36 | $73.93 | $92.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $130.93 / $130.93 / $130.93
| Professional | | $130.93 | $130.93 | $130.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $27.05 / $39.50 / $58.61
| Professional | | $27.05 | $39.50 | $58.61 |