- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $152.28 / $975.91 / $1,073.71
| Facility | | $152.28 | $975.91 | $1,073.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $118.61 / $152.28 / $167.23
| Professional | | $118.61 | $152.28 | $167.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $8.01 / $8.01 / $8.01
| Professional | | $8.01 | $8.01 | $8.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $14.23 / $14.23 / $14.23
| Professional | | $14.23 | $14.23 | $14.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $152.28 / $152.28 / $255.83
| Facility | | $152.28 | $152.28 | $255.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $155.00 / $155.00 / $329.00
| Professional | | $155.00 | $155.00 | $329.00 |