- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $220.00 / $220.00 / $307.05
| Facility | | $220.00 | $220.00 | $307.05 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.77 / $45.51 / $64.58
| Professional | | $32.77 | $45.51 | $64.58 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $66.63 / $82.80 / $165.70
| Facility | | $66.63 | $82.80 | $165.70 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $41.45 / $52.38 / $61.62
| Professional | | $41.45 | $52.38 | $61.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $40.81 / $69.56 / $103.96
| Professional | | $40.81 | $69.56 | $103.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $45.76 / $59.01 / $85.44
| Professional | | $45.76 | $59.01 | $85.44 |