- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $32.14 / $155.52 / $622.08
| Facility | | $32.14 | $155.52 | $622.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.14 / $47.03 / $52.91
| Professional | | $32.14 | $47.03 | $52.91 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $192.78 / $192.78 / $192.78
| Professional | | $192.78 | $192.78 | $192.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $33.31 / $33.31 / $33.31
| Facility | | $33.31 | $33.31 | $33.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $33.31 / $33.31 / $39.19
| Professional | | $33.31 | $33.31 | $39.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $108.63 / $108.63 / $120.70
| Professional | | $108.63 | $108.63 | $120.70 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $31.35 / $32.65 / $42.46
| Professional | | $31.35 | $32.65 | $42.46 |