- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $23.44 / $891.25 / $1,096.48
| Facility | | $23.44 | $891.25 | $1,096.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $30.20 / $47.86 / $398.11
| Professional | | $30.20 | $47.86 | $398.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $144.54 / $204.17 / $309.03
| Professional | | $144.54 | $204.17 | $309.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $19.95 / $57.54 / $158.49
| Professional | | $19.95 | $57.54 | $158.49 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $34.67 / $69.18 / $407.38
| Professional | | $34.67 | $69.18 | $407.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $45.71 / $57.54 / $83.18
| Professional | | $45.71 | $57.54 | $83.18 |