- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $44.67 / $371.54 / $537.03
| Facility | | $44.67 | $371.54 | $537.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $33.11 / $57.54 / $630.96
| Professional | | $33.11 | $57.54 | $630.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $234.42 / $269.15 / $302.00
| Professional | | $234.42 | $269.15 | $302.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $223.87 / $316.23 / $501.19
| Professional | | $223.87 | $316.23 | $501.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $117.49 / $208.93 / $363.08
| Professional | | $117.49 | $208.93 | $363.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $100.00 / $100.00 / $100.00
| Facility | | $100.00 | $100.00 | $100.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $47.86 / $316.23 / $316.23
| Professional | | $47.86 | $316.23 | $316.23 |