- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $126.16 / $147.41 / $226.15
| Facility | | $126.16 | $147.41 | $226.15 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $57.82 / $72.28 / $336.50
| Professional | | $57.82 | $72.28 | $336.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $32.56 / $32.56 / $40.63
| Facility | | $32.56 | $32.56 | $40.63 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $32.56 / $32.56 / $195.00
| Facility | | $32.56 | $32.56 | $195.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $55.00 / $65.00 / $129.01
| Professional | | $55.00 | $65.00 | $129.01 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $32.56 / $32.56 / $40.63
| Facility | | $32.56 | $32.56 | $40.63 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $60.00 / $80.30 / $195.00
| Facility | | $60.00 | $80.30 | $195.00 |