- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $120.51 / $128.27 / $279.63
| Facility | | $120.51 | $128.27 | $279.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $118.75 / $133.03 / $186.40
| Professional | | $118.75 | $133.03 | $186.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $64.00 / $64.00 / $64.00
| Facility | | $64.00 | $64.00 | $64.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $33.15 / $303.29 / $477.70
| Professional | | $33.15 | $303.29 | $477.70 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $327.18 / $490.77 / $843.78
| Professional | | $327.18 | $490.77 | $843.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $40.00 / $40.00 / $50.00
| Professional | | $40.00 | $40.00 | $50.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $70.00 / $70.00 / $70.00
| Professional | | $70.00 | $70.00 | $70.00 |