- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $64.57 / $162.18 / $363.08
| Facility | | $64.57 | $162.18 | $363.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $8.91 / $524.81 / $1,023.29
| Professional | | $8.91 | $524.81 | $1,023.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.88 / $2.88 / $2.88
| Professional | | $2.88 | $2.88 | $2.88 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $64.57 / $162.18 / $363.08
| Facility | | $64.57 | $162.18 | $363.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $8.91 / $8.91 / $1,023.29
| Professional | | $8.91 | $8.91 | $1,023.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.36 / $32.36 / $33.88
| Professional | | $32.36 | $32.36 | $33.88 |