- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $44.67 / $288.40 / $478.63
| Facility | | $44.67 | $288.40 | $478.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $34.67 / $50.12 / $562.34
| Professional | | $34.67 | $50.12 | $562.34 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $0.02 / $0.02 / $0.03
| Facility | | $0.02 | $0.02 | $0.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $223.87 / $263.03 / $263.03
| Professional | | $223.87 | $263.03 | $263.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $239.88 / $281.84 / $416.87
| Professional | | $239.88 | $281.84 | $416.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $107.15 / $107.15 / $109.65
| Professional | | $107.15 | $107.15 | $109.65 |