- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $77.62 / $120.23 / $524.81
| Facility | | $77.62 | $120.23 | $524.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $77.62 / $77.62 / $144.54
| Professional | | $77.62 | $77.62 | $144.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $102.33 / $102.33 / $199.53
| Facility | | $102.33 | $102.33 | $199.53 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $50.12 / $102.33 / $398.11
| Professional | | $50.12 | $102.33 | $398.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $64.57 / $64.57 / $50,118.72
| Facility | | $64.57 | $64.57 | $50,118.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $54.95 / $54.95 / $134.90
| Professional | | $54.95 | $54.95 | $134.90 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $109.65 / $109.65 / $114.82
| Professional | | $109.65 | $109.65 | $114.82 |