- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $30.20 / $416.87 / $446.68
| Facility | | $30.20 | $416.87 | $446.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $30.20 / $57.54 / $426.58
| Professional | | $30.20 | $57.54 | $426.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3.16 / $3.98 / $7.94
| Professional | | $3.16 | $3.98 | $7.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $138.04 / $213.80 / $302.00
| Professional | | $138.04 | $213.80 | $302.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $169.82 / $281.84 / $302.00
| Professional | | $169.82 | $281.84 | $302.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $45.71 / $67.61 / $100.00
| Professional | | $45.71 | $67.61 | $100.00 |