- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $302.13 / $435.43 / $523.72
| Facility | | $302.13 | $435.43 | $523.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $30.90 / $31.32 / $38.86
| Professional | | $30.90 | $31.32 | $38.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $28.00 / $33.51 / $42.56
| Professional | | $28.00 | $33.51 | $42.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $22.97 / $32.89 / $103.01
| Professional | | $22.97 | $32.89 | $103.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $41.76 / $52.20 / $62.64
| Professional | | $41.76 | $52.20 | $62.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $16.64 / $18.79 / $38.00
| Professional | | $16.64 | $18.79 | $38.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $20.88 / $40.98 / $40.98
| Professional | | $20.88 | $40.98 | $40.98 |