- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $256.02 / $460.84 / $921.67
| Facility | | $256.02 | $460.84 | $921.67 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $19.93 / $23.03 / $31.00
| Professional | | $19.93 | $23.03 | $31.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $153.38 / $200.17 / $244.64
| Facility | | $153.38 | $200.17 | $244.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $37.67 / $37.67 / $37.67
| Professional | | $37.67 | $37.67 | $37.67 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7.00 / $64.33 / $114.88
| Facility | | $7.00 | $64.33 | $114.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $13.60 / $31.80 / $39.75
| Professional | | $13.60 | $31.80 | $39.75 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3.15 / $17.17 / $56.09
| Professional | | $3.15 | $17.17 | $56.09 |