- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $236.06 / $247.74 / $272.79
| Facility | | $236.06 | $247.74 | $272.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $182.81 / $272.79 / $290.74
| Professional | | $182.81 | $272.79 | $290.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $11.85 / $15.81 / $15.81
| Professional | | $11.85 | $15.81 | $15.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $331.44 / $331.44 / $331.44
| Facility | | $331.44 | $331.44 | $331.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $259.67 / $1,389.17 / $1,389.17
| Professional | | $259.67 | $1,389.17 | $1,389.17 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $45.00 / $45.00 / $45.00
| Professional | | $45.00 | $45.00 | $45.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $207.73 / $271.47 / $342.29
| Professional | | $207.73 | $271.47 | $342.29 |