- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $41.27 / $548.17 / $1,096.35
| Facility | | $41.27 | $548.17 | $1,096.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $37.39 / $54.72 / $171.00
| Professional | | $37.39 | $54.72 | $171.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $81.54 / $108.60 / $162.47
| Professional | | $81.54 | $108.60 | $162.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $61.33 / $115.51 / $172.53
| Professional | | $61.33 | $115.51 | $172.53 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $41.27 / $66.80 / $112.32
| Facility | | $41.27 | $66.80 | $112.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $63.52 / $120.54 / $304.88
| Professional | | $63.52 | $120.54 | $304.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $63.52 / $113.45 / $139.74
| Professional | | $63.52 | $113.45 | $139.74 |