- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $217.72 / $330.19 / $355.76
| Facility | | $217.72 | $330.19 | $355.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $15.09 / $21.84 / $27.08
| Professional | | $15.09 | $21.84 | $27.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $31.32 / $31.32 / $31.32
| Facility | | $31.32 | $31.32 | $31.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $11.20 / $17.30 / $64.14
| Professional | | $11.20 | $17.30 | $64.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $20.65 / $26.23 / $45.00
| Professional | | $20.65 | $26.23 | $45.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $9.83 / $14.94 / $22.21
| Professional | | $9.83 | $14.94 | $22.21 |