- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $42.69 / $606.00 / $2,831.76
| Facility | | $42.69 | $606.00 | $2,831.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $36.76 / $84.79 / $96.43
| Professional | | $36.76 | $84.79 | $96.43 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $38.36 / $99.71 / $141.72
| Professional | | $38.36 | $99.71 | $141.72 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $217.34 / $682.93 / $1,577.95
| Facility | | $217.34 | $682.93 | $1,577.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $101.56 / $130.44 / $308.66
| Professional | | $101.56 | $130.44 | $308.66 |